Comprehensive i-Human Case Analysis:
Developmental Concern
Walden University Week #7 (2026) | Parent
Report: "Prefers to play alone"
Presenting Concern: During a well-child visit for Maya Chen, a 3-year-old female, her mother
expresses this worry: "My daughter doesn't interact with other children and prefers to play
alone. She lines up her toys but doesn't pretend with them. At her cousin's birthday party last
week, she spent the entire time organizing the crayons by color instead of eating cake with
the other kids."
Background: Maya is an only child, born full-term via uncomplicated vaginal delivery. She sat
at 6 months, walked at 13 months, and said her first words at 15 months. She currently
speaks in 3-4 word phrases. She has had three ear infections but passed her newborn hearing
screen. Family recently relocated; this is her first visit to your practice.
Module 1: Initial Triage & History
Q1: Characterizing the Social Concern
What is the SINGLE most important follow-up question to better characterize this social
concern and differentiate ASD from typical temperament variations?
A. "Has she always been shy around new people, or is this behavior new since the move?"
B. "Does she ever point to interesting things to show you, or bring objects over to share her
attention with you?" [CORRECT]
C. "How many hours per week does she spend in daycare or preschool settings?"
D. "Do you or your husband consider yourselves to be introverted or socially anxious?"
Correct Answer: B
Rationale: Joint attention behaviors (pointing to show, bringing objects to share interest)
represent the most discriminative domain for differentiating ASD from shyness or social
reticence. These skills typically emerge between 9-14 months and are fundamental
precursors to social communication. A child with social anxiety or typical shyness will still
, demonstrate joint attention and social reciprocity with familiar caregivers, whereas deficits in
joint attention are a core DSM-5-TR criterion for ASD (Criterion A1: "Deficits in
social-emotional reciprocity"). The mother's report of organizing crayons by color rather than
social engagement further supports concern for restricted/repetitive interests.
Distractor Analysis:
● A addresses temporal onset but "shyness" is a temperament trait, not a developmental skill;
even "shy" children show joint attention.
● C assesses exposure but confuses correlation with causation; lack of social exposure doesn't
explain repetitive toy lining.
● D explores familial traits but risks normalizing concerning symptoms; ASD is highly heritable,
but this question doesn't assess Maya's specific skill deficits.
Q2: Essential Elements of Developmental History - Select All That Apply
You decide to obtain a comprehensive developmental history. Which elements are
ESSENTIAL to include when evaluating a preschooler with social communication concerns?
Select all that apply.
A. Detailed prenatal and birth history, including maternal infections or complications
[CORRECT]
B. Regression history—any loss of previously acquired language or social skills [CORRECT]
C. Current screen time duration and content exposure
D. Presence of repetitive motor mannerisms (hand-flapping, toe-walking, spinning) [CORRECT]
E. Sensory processing patterns (hypo- or hyper-sensitivity to sound, texture, light) [CORRECT]
F. Feeding patterns and food texture preferences during infancy
G. Family history of ASD, language disorders, or learning disabilities [CORRECT]
H. Age-appropriate pretend play and imitation skills [CORRECT]
Correct Answers: A, B, D, E, G, H
Rationale:
● A (Correct): Prenatal factors (maternal diabetes, infection) and birth complications (hypoxia)
are established risk factors for neurodevelopmental differences.
Developmental Concern
Walden University Week #7 (2026) | Parent
Report: "Prefers to play alone"
Presenting Concern: During a well-child visit for Maya Chen, a 3-year-old female, her mother
expresses this worry: "My daughter doesn't interact with other children and prefers to play
alone. She lines up her toys but doesn't pretend with them. At her cousin's birthday party last
week, she spent the entire time organizing the crayons by color instead of eating cake with
the other kids."
Background: Maya is an only child, born full-term via uncomplicated vaginal delivery. She sat
at 6 months, walked at 13 months, and said her first words at 15 months. She currently
speaks in 3-4 word phrases. She has had three ear infections but passed her newborn hearing
screen. Family recently relocated; this is her first visit to your practice.
Module 1: Initial Triage & History
Q1: Characterizing the Social Concern
What is the SINGLE most important follow-up question to better characterize this social
concern and differentiate ASD from typical temperament variations?
A. "Has she always been shy around new people, or is this behavior new since the move?"
B. "Does she ever point to interesting things to show you, or bring objects over to share her
attention with you?" [CORRECT]
C. "How many hours per week does she spend in daycare or preschool settings?"
D. "Do you or your husband consider yourselves to be introverted or socially anxious?"
Correct Answer: B
Rationale: Joint attention behaviors (pointing to show, bringing objects to share interest)
represent the most discriminative domain for differentiating ASD from shyness or social
reticence. These skills typically emerge between 9-14 months and are fundamental
precursors to social communication. A child with social anxiety or typical shyness will still
, demonstrate joint attention and social reciprocity with familiar caregivers, whereas deficits in
joint attention are a core DSM-5-TR criterion for ASD (Criterion A1: "Deficits in
social-emotional reciprocity"). The mother's report of organizing crayons by color rather than
social engagement further supports concern for restricted/repetitive interests.
Distractor Analysis:
● A addresses temporal onset but "shyness" is a temperament trait, not a developmental skill;
even "shy" children show joint attention.
● C assesses exposure but confuses correlation with causation; lack of social exposure doesn't
explain repetitive toy lining.
● D explores familial traits but risks normalizing concerning symptoms; ASD is highly heritable,
but this question doesn't assess Maya's specific skill deficits.
Q2: Essential Elements of Developmental History - Select All That Apply
You decide to obtain a comprehensive developmental history. Which elements are
ESSENTIAL to include when evaluating a preschooler with social communication concerns?
Select all that apply.
A. Detailed prenatal and birth history, including maternal infections or complications
[CORRECT]
B. Regression history—any loss of previously acquired language or social skills [CORRECT]
C. Current screen time duration and content exposure
D. Presence of repetitive motor mannerisms (hand-flapping, toe-walking, spinning) [CORRECT]
E. Sensory processing patterns (hypo- or hyper-sensitivity to sound, texture, light) [CORRECT]
F. Feeding patterns and food texture preferences during infancy
G. Family history of ASD, language disorders, or learning disabilities [CORRECT]
H. Age-appropriate pretend play and imitation skills [CORRECT]
Correct Answers: A, B, D, E, G, H
Rationale:
● A (Correct): Prenatal factors (maternal diabetes, infection) and birth complications (hypoxia)
are established risk factors for neurodevelopmental differences.
