Approach to neurodevelopmental disorders Quiz: Ace Your Exams

A 10-year-old girl is brought to the psychiatric clinic by caregivers for difficulty interacting with peers and repetitive behaviors that have worsened over the past 10 months. These behaviors have been present for as long as the caregivers can remember but appear to have intensified since starting at a new school. Caregivers report the patient does not make eye contact, shows little interest in imaginative play, and becomes irritable if meals change. Recently, the patient became irate when the classroom was rearranged for a holiday party. The teacher notes her struggles in communicating with classmates and a preference for reading books about the ocean. Although speech onset was later than expected, the patient currently speaks and reads at an 8th grade level. Vital signs are within normal limits. Mental status exam reveals a limited range of affect, poor eye contact, and repetitive foot tapping. Which of the following is the most likely diagnosis?