You meet with a 4-year-old male (Robert) and his parents during a screening session in your office. You asked his parents to complete some surveys and permission forms prior to the meeting. From previous conversations with the mother, you know that their major concern is that Robert does not like to play with other children and, according to them, that is the reason that he has not began to speak yet.

When you meet Robert, you discover that he is a playful little boy who is well attached to his parents but who does not make eye contact when you meet him. During your play session, he does not speak at all, but instead points to the toys that he wants. He plays but when you attempt to play with him, he leaves the play area and points to another toy, leaving the toy that he was playing with for you. You ask the parents later and discover that he has two older sisters who speak for him and who communicate with him when he points. Further, you notice that he does not make eye contact with you when you call to him. To see how he acts with other children, you have him join a playgroup of varied age children. During this time, you watch him as he shies away from the group, he does not even point to toys, instead he goes to an unoccupied corner and sits down without playing with any children.

After playing with him, you administer other tests to find that his intelligence appears to be average for a 4-year-old and so, there no concerns about his cognitive skills. Still unsure about his delayed speech development and lack of appropriate social skills, you make some recommendations to the parents.