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Tim is a 4-year-old boy who has had a 12-month history of behavioural problems This is evident by his physical aggression towards family members teachers and other children not listening to parental instruction punches and kicks when he does not get his way and his quick temper This behaviour has led to failure to develop peer relationships Tims mother has also self reported herself to the DHS out of fear of lashing out on Tim due to her difficulties managing his behaviour and has on occasion locked him in the back yard as Tim is likely to wreck the place when left on his own which shows a defiance of rules poor and on the go behaviour Tim has had several major operations including correction of hip dysplasia resulting in him being in a lower body cast for his first 18 months of life which explains his inability to walk until the age of 3 grommets inserted due to ear infections and a correction of a bowl obstruction which explains his toileting problemsHe tends to hold gaze for longer than usual suggesting impairment in non-verbal behaviour and he is very clumsy and does not react significantly to pain of falling over or bumping into things His speech is also difficult to understand although Mum is able to interpret Tim obtained a Full Scale score of 72 in the WPPSI which is the approximate score for a possible intellectual disability What is your diagnosis What is your differential diagnosisPrimary Diagnosis see Table 1Tims Full Scale score of 72 on the WPPSI his deficits and impairments in communication home living socialinterpersonal skills health and safety and the onset being prior to the age of 18 indicate a Mild Intellectual DisabilityDifferential Diagnosis May IncludeTims persistent eye-contact failure to develop peer relationships and delay in development of spoken language indicates that he may have Autistic Disorder However he presents with no symptoms of repetitive or stereotyped patterns of
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