Autism spectrum disorder — viva

Opening (must-hit)

“I will take a multi-setting developmental and social-communication history, observe interaction, arrange hearing assessment, start supports if concern is high, and complete a multidisciplinary diagnostic formulation using DSM-5 domains rather than waiting for a single lab test.” [1] [2]

Branch A — Criteria

Examiner: Define ASD for a fellowship answer.
Candidate: Persistent deficits in all three social-communication domains plus restricted/repetitive behaviours in at least two of four domains, early developmental onset, and clinically significant impairment, not better explained by intellectual disability alone. Severity levels rate support needs. [1]

Branch B — Differentials

Examiner: What else is on your list?
Candidate: Hearing loss, isolated language disorder, SCD without RRBs, ADHD, social anxiety/selective mutism, intellectual disability alone, trauma/attachment patterns, and regression syndromes with neurological red flags. Dual diagnosis with ADHD is allowed when both are present. [1] [2]

Branch C — Investigations

Examiner: Which tests today?
Candidate: Audiology is mandatory. Genetic evaluation after diagnosis often includes microarray and fragile X pathways when indicated. MRI and EEG are not routine without neurological red flags. Before any antipsychotic I need metabolic baseline and safety labs as indicated. [1] [2] [3]

Branch D — Early supports

Examiner: Diagnosis will take months. What now?
Candidate: Start speech-language therapy, early intervention and parent-mediated approaches now. PACT and ESDM are landmark evidence anchors for parent-mediated and early developmental intervention. Education adjustments should not wait for the final letter. [1] [5]

Branch E — Irritability pharmacology

Examiner: Parents demand a tablet for meltdowns.
Candidate: First functional analysis and medical pain/sleep screen; structured parent training. If severe irritability with safety risk persists, risperidone (RUPP) or aripiprazole with low-start dosing and metabolic monitoring. Not for core social deficits. Not SSRI for core RRBs — King citalopram trial was negative. [3] [4] [6]

Branch F — Adolescent risk

Examiner: At 15 she is withdrawn and self-harming.
Candidate: Do not diagnostic-overshadow. Assess depression and suicide risk directly; safety plan; adapt communication; involve trusted supports; escalate mental health care. Premature mortality and suicide risk data make passive reassurance unsafe. [7]

Branch G — Vaccines

Examiner: Father blames immunisation.
Candidate: Vaccines do not cause autism. I state that clearly, explore fears, and keep the therapeutic alliance so the child still receives care and catch-up vaccines if needed. [1]

Close

Summarise problem representation, supports started, diagnostic pathway, safety-net, and follow-up owner in plain language with teach-back. [1]