Diagnosing the ‘strange’ child

Summary The diagnosis of children with a spectrum of autistic features, who do not qualify for the diagnosis of classical autism, has increased during the past decade. A case is reported of an 8‐year‐old child originally diagnosed as learning disabled with attention disorders and hyperactivity, who was later diagnosed as having an autistic spectrum disorder when abnormalities of social interaction and play activity became more obvious. The frequency of learning and attention problems in school‐age children may obscure more significant psychiatric pathologies, such as autistic disorders. Improved awareness of disorders of social functioning and play activity in the school‐age child and use of screening tools may lead to earlier detection, definitive diagnosis and treatment for these children. In addition, assessments from multiple sources, i.e. the school, the home and the clinic, are needed in the diagnostic process. Periodic re‐evaluations of the school‐age child with problem behaviour are necessary to insure that more significant pathologies, which were not clear on initial evaluation, are diagnosed at the earliest opportunity.