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Diagnosing autism spectrum disorder (ASD) among adults
  1. Toshi A Furukawa
  1. Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; furukawa@kuhp.kyoto-u.ac.jp

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Clinical case

Patient: 18-year-old man

Present illness: The patient was brought to your department of psychiatry by his worried mother. While the patient sat still on the chair, directing an unmoving suspicious gaze towards you, his mother explained in a hurried, high-pitched voice, as follows: “Adam (the patient's name) has always been an odd boy. We've recently heard a lot about Asperger's syndrome and autism in the newspapers and on TV. I'm convinced that he suffers from them and told our family doctor, but he wasn't sure and sent us to you. Adam was very difficult to raise from the very beginning. Maybe he was a bit late in starting to walk or to talk but we did not think it was unusual, in comparison with his sister. When he went to the kindergarten and to primary school, he never had any friends. He always played alone and was interested in cartoon monsters. All he did was to collect monster cards. Things just had to be the way he wanted and he had tantrums when something unexpected happened. Oh yes, he also killed a lot of frogs with firecrackers—isn't this weird? Isn't he a weird boy? He was never good at school, probably always the worst or the second worst in class, and kids started bullying him. He started skipping class, but with understanding teachers he has so far managed to finish primary school and junior high school, and he is now a senior in high school. But he probably will now have to drop out: he has not gone to school for two months now. I am so worried. What will he do for his life?”

Present status: All this while Adam sat still, without changing his facial expression except for occasional grimaces. When asked what he himself thought was his problems, he …

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