This case study involves a 5-year-old child born in London who received follow-up treatment in child psychiatry in Spain for 2 years due to delay in language development and disorders of conduct. The patient had previously received medical care in London. From a very young age the patient had a history of repeated otitis, which was treated symptomatically. During his stay in London, the child was examined by many paediatricians, paediatric neurologists and psychiatrists, who diagnosed the child as having autism spectrum disorder because of the presence of a qualitative change in social interaction, a qualitative alteration in communication, restricted and stereotyped behaviour patterns and activities, delay in the language used for social communication and lack of imaginative play.
After 2 years of living in Spain with his mother, he was placed in a public school in Madrid for the first time at 3 years of age. The teachers observed significant delays in language development, some of which were the result of having spent his first 3 years living between two countries with different languages. Professionals from the school suspected hearing loss due to difficulties in social interaction. The school psychologist reported an inability to establish appropriate relationships with peers, lack of empathy, lack of interaction in games with other children, stereotyped use of language with an inability to initiate or maintain a conversation, and presence of stereotyped and repetitive motor mannerisms. The school also reported low tolerance to frustration and frequent episodes of self-aggressive behaviour, such as biting his arm and hitting his head.
The psychologist referred the child to the San Carlos Clinical Hospital. During initial interviews with the patient and his mother in the children’s psychiatry unit, the behaviours noted above were observed and recorded. His mother stated that during episodes of otitis, there was an exacerbation of ritualised behaviours and episodes of self-aggressive behaviours. We decided to refer the case to otolaryngology services to assess the possibility of surgery, given the existence of frequent repetitive otitis and otalgia refractory to symptomatic treatment.
During surgery for otitis, the otolaryngologist observed and removed an adenoidea hypertrophy. Approximately 1 month after the surgery, we made a psychopathological examination, reporting that the child was conscious, oriented and affable, as well as well groomed. Although he did not maintain eye contact, he was reactive to stimuli, responding when spoken to and did not show evidence of stereotypies or mannerisms. The child showed some tension when speaking, responding with short phrases when asked, and seemed slightly suspicious. There was no evidence of psychosis or somatic alterations in circadian disorders or loss of appetite or weight. The child played spontaneously during the interview, and was affectionate and loving with his mother as well as the therapists at the end of the interview.
The school and the family both reported significant improvement in the patient post surgery. A 6-month follow-up revealed a lasting qualitative increase in social interaction, and while the child’s tendency is to play alone, he is becoming increasingly sociable with other children from school. There is an improvement in his language shown by the disappearance of echolalia, improved literacy, virtual absence of stereotypies and mannerisms, and reduced episodes of self-aggressive behaviour. The child still displays a low tolerance for frustration and poor maintenance of eye contact, but gives the impression of being more connected with his environment.
