Differential Diagnosis
- Single most likely diagnosis
- E) Pervasive developmental disorder: This diagnosis is the most likely due to the patient's preference for being alone, lack of social interaction with peers, and repetitive behavior (carrying the doll everywhere). The patient's difficulty with eye contact, tendency to repeat words, and being easily distraught when separated from the doll also support this diagnosis.
- Other Likely diagnoses
- B) Mild intellectual developmental disorder: Although the patient answers direct questions, her lack of participation in games and tendency to drift off may indicate some cognitive or intellectual difficulties. However, the physical examination and the patient's ability to answer questions suggest that this might not be the primary issue.
- A) Learning disorder: The patient's being "often off task and distracted" in class could suggest a learning disorder, but this symptom alone is not sufficient to make this the primary diagnosis, given the other more prominent symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- None specifically identified in this scenario: The provided information does not point towards a condition that would be immediately life-threatening if missed. However, it's crucial to consider conditions like autism spectrum disorder (which could be considered under the umbrella of pervasive developmental disorders) due to its implications for long-term care and support.
- Rare diagnoses
- Attachment disorder: Although the patient's behavior with the doll could suggest an attachment issue, the information provided does not strongly support this as a primary diagnosis. The patient's distress when without the doll might be more indicative of a comfort object in the context of a pervasive developmental disorder rather than an attachment disorder.
- Selective mutism: The patient's occasional repetition of the physician's words and lack of engagement could raise concerns about selective mutism, but this diagnosis does not account for the full range of symptoms described, such as the preference for solitude and the specific behavior with the doll.