Arjinder is 27 months old and comes to the clinic with his Grandmother. Arjinder’s family are concerned because he does not turn towards the members of his family when they come into the room and despite them calling his name, he does not seem to show any recognition of his name nor the significant people in his life. Arjinder has had a hearing test and all appears to be normal.

While Arjinder is sitting on his Grandmother’s lap during the consultation he seems to be hearing the whir of the computer fan on your desk and occasionally turns towards the ticking of the clock on the wall. Arjinder does not respond to his Grandmother’s voice and does not show any particular reaction when you call him by name. You wind up a toy in front of him and he immediately pays attention to the winding noise and the subsequent actions of the toy.

Strategies

• Suspected hearing impairment and a lack of response to family members are two key alerting signals to a possible diagnosis of ASD.
• It is still important to assess for hearing loss.
• Consider referral for a multi-disciplinary assessment where a full developmental history can be taken.