COMPREHENSIVE I-HUMAN CASE STUDY (Toddler with Social
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Patient Profile
Age: 22 months (~1 year 10 months)
Gender: Male
Developmental Status: Toddler, ambulatory, speaking 2–3 word phrases
Caregiver: Mother (primary source of history)
Setting: Outpatient pediatric clinic / developmental assessment
,COMPREHENSIVE I-HUMAN CASE STUDY (Toddler with Social
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Case Overview
The patient is a 22-month-old toddler brought by his mother due to difficulty
interacting with peers and limited social engagement. The mother reports concerns
about delayed social communication, restricted interests, and repetitive behaviors.
The purpose of this i-Human case is to assess the learner’s ability to perform
developmental history-taking, behavioral assessment, screening for autism
spectrum disorder (ASD), differential diagnosis, and early intervention planning.
Chief Complaint (CC)
“My child doesn’t seem to play well with other kids, and I’m worried he may have
autism.”
History of Present Illness (HPI) – Summary
The mother reports that her 22-month-old son has limited eye contact, infrequent
response to his name, and minimal interest in playing with other children. He
demonstrates repetitive hand movements and lining up toys, and shows intense
focus on specific objects. Language is limited to a few words or short phrases. He is
otherwise healthy, eats well, sleeps normally, and meets gross motor milestones
(walking, running).
No history of regression or loss of skills is reported. The mother expresses concern
about social and communication development and requests evaluation for
suspected autism spectrum disorder (ASD).
HPI Interview (Caregiver–Clinician Dialogue)
,COMPREHENSIVE I-HUMAN CASE STUDY (Toddler with Social
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Clinician: What brought your child in today?
Mother: I’m worried because he doesn’t play with other children and rarely makes eye
contact.
Clinician: How old is he now?
Mother: 22 months.
Clinician: Can you tell me about his speech?
Mother: He says a few words, like “mama” and “ball,” but doesn’t make sentences yet.
Clinician: Does he respond when you call his name?
Mother: Sometimes, but often he seems to ignore us.
Clinician: Any repetitive movements or unusual behaviors?
Mother: Yes, he flaps his hands and lines up his toy cars in a row.
Clinician: How does he interact with other children?
Mother: He prefers to play alone and doesn’t share toys.
Clinician: Any medical or developmental problems so far?
Mother: No, he’s otherwise healthy and walks and runs well.
Review of Systems
Neurological: Alert, gross motor milestones achieved, fine motor repetitive
movements noted
Developmental/Behavioral: Limited social interaction, minimal joint attention,
restricted interests
General: No feeding, sleep, or growth problems
Other Systems: Unremarkable
, COMPREHENSIVE I-HUMAN CASE STUDY (Toddler with Social
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Vital Signs
Vital Sign Value
Temperature 36.7°C
Heart Rate 100 bpm
Respiratory Rate 22 breaths/min
Blood Pressure 90/60 mmHg
Oxygen Saturation 98%
Weight 12.5 kg (within 25–50th percentile)
Height 85 cm (50th percentile)
Past Medical History (PMH)
Full-term birth, normal delivery
No NICU admission
Vaccinations up to date
No chronic illnesses
Past Surgical History
None
Medications
None
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Patient Profile
Age: 22 months (~1 year 10 months)
Gender: Male
Developmental Status: Toddler, ambulatory, speaking 2–3 word phrases
Caregiver: Mother (primary source of history)
Setting: Outpatient pediatric clinic / developmental assessment
,COMPREHENSIVE I-HUMAN CASE STUDY (Toddler with Social
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Case Overview
The patient is a 22-month-old toddler brought by his mother due to difficulty
interacting with peers and limited social engagement. The mother reports concerns
about delayed social communication, restricted interests, and repetitive behaviors.
The purpose of this i-Human case is to assess the learner’s ability to perform
developmental history-taking, behavioral assessment, screening for autism
spectrum disorder (ASD), differential diagnosis, and early intervention planning.
Chief Complaint (CC)
“My child doesn’t seem to play well with other kids, and I’m worried he may have
autism.”
History of Present Illness (HPI) – Summary
The mother reports that her 22-month-old son has limited eye contact, infrequent
response to his name, and minimal interest in playing with other children. He
demonstrates repetitive hand movements and lining up toys, and shows intense
focus on specific objects. Language is limited to a few words or short phrases. He is
otherwise healthy, eats well, sleeps normally, and meets gross motor milestones
(walking, running).
No history of regression or loss of skills is reported. The mother expresses concern
about social and communication development and requests evaluation for
suspected autism spectrum disorder (ASD).
HPI Interview (Caregiver–Clinician Dialogue)
,COMPREHENSIVE I-HUMAN CASE STUDY (Toddler with Social
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Clinician: What brought your child in today?
Mother: I’m worried because he doesn’t play with other children and rarely makes eye
contact.
Clinician: How old is he now?
Mother: 22 months.
Clinician: Can you tell me about his speech?
Mother: He says a few words, like “mama” and “ball,” but doesn’t make sentences yet.
Clinician: Does he respond when you call his name?
Mother: Sometimes, but often he seems to ignore us.
Clinician: Any repetitive movements or unusual behaviors?
Mother: Yes, he flaps his hands and lines up his toy cars in a row.
Clinician: How does he interact with other children?
Mother: He prefers to play alone and doesn’t share toys.
Clinician: Any medical or developmental problems so far?
Mother: No, he’s otherwise healthy and walks and runs well.
Review of Systems
Neurological: Alert, gross motor milestones achieved, fine motor repetitive
movements noted
Developmental/Behavioral: Limited social interaction, minimal joint attention,
restricted interests
General: No feeding, sleep, or growth problems
Other Systems: Unremarkable
, COMPREHENSIVE I-HUMAN CASE STUDY (Toddler with Social
Difficulties and Suspected Autism) COMPLETE ASSESSMENT,
DIAGNOSIS AND MANAGEMENT PLANS LATEST 2026
Vital Signs
Vital Sign Value
Temperature 36.7°C
Heart Rate 100 bpm
Respiratory Rate 22 breaths/min
Blood Pressure 90/60 mmHg
Oxygen Saturation 98%
Weight 12.5 kg (within 25–50th percentile)
Height 85 cm (50th percentile)
Past Medical History (PMH)
Full-term birth, normal delivery
No NICU admission
Vaccinations up to date
No chronic illnesses
Past Surgical History
None
Medications
None
