History Taking · Intermediate · Paediatrics

Child with Concerns About Social Interaction and Repetitive Behaviours

Practise this PLAB 2 history taking station on Autism Spectrum Disorder. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Mrs Maureen Orr has brought her 2-year-old daughter Lily to see you. She is concerned about Lily's social development, noting that she does not make eye contact consistently, seems to prefer playing alone, and has some repetitive behaviours. She wonders if Lily might have autism spectrum disorder. Please take a focused developmental history and discuss assessment pathways.

Background notes: PMH: Born 40 weeks, birthweight 3.3kg, normal delivery. No neonatal complications. Hearing checks normal (newborn

What this station tests

  • Assessing the two core ASD domains: social communication (eye contact, pointing, joint attention, pretend play) and restricted/repetitive behaviours (lining up, routines, sensory sensitivities)
  • Proto-declarative pointing as a key milestone: pointing to share interest, not just to request
  • Not diagnosing ASD in primary care: referring for specialist multidisciplinary assessment
  • Framing referral as understanding the child's needs, not as labelling
  • Checking for regression: loss of skills raises concern for Rett syndrome or other conditions

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

Parental concern about autism requires the candidate to take a structured developmental history focusing on social communication and restricted behaviours, while being sensitive about a diagnosis that carries significant emotional weight. Lily is 2 years 4 months, her mother Maureen is concerned about social interaction and repetitive behaviours. Open with: 'Maureen, tell me what you have noticed about Lily that concerns you.'

Core approach

Assess the two core ASD domains. Social communication: does Lily make eye contact? (Reduced.) Does she point to share interest (proto-declarative pointing)? (Not reliably.) Does she respond to her name? (Inconsistently.) Does she show joint attention (looking where you point)? Does she engage in pretend play? (Limited.) Does she play with other children? (Prefers solitary play.) How many words? Receptive language?

Restricted, repetitive behaviours: does she line up toys? (Yes.) Does she insist on routines? (Yes, becomes distressed with changes.) Does she flap her hands or have other repetitive movements? Does she have intense interests in specific objects or topics? Sensory sensitivities (covering ears, dislike of textures)?

Compare with sibling. Older brother Noah (4) is developing typically. Maureen is comparing and noticing differences. This comparison is often what prompts parental concern and is valid.

Check hearing (may contribute to apparent social withdrawal). Check for regression (loss of previously acquired words or skills would be a red flag for Rett syndrome or other conditions).

Closing and safety netting

Communicate sensitively. 'Maureen, the features you have described, the reduced eye contact, the limited pointing, the preference for solitary play, and the need for routine, are things that we take seriously. I would like to refer Lily for a specialist developmental assessment to understand her needs better.' Do not diagnose ASD in primary care, but do not dismiss the concern.

Referral pathway: community paediatrics or child development centre for multidisciplinary assessment (speech and language, educational psychology, developmental paediatrician). Hearing test. Arrange nursery or health visitor input for additional observations.

Reassure: 'Whatever the outcome of the assessment, the earlier we understand Lily's needs, the better we can support her. Many children with these features do very well with the right support.' Address her fear: 'This is not about labelling Lily. It is about understanding how she experiences the world and helping her thrive.' Safety net: if regression occurs (loss of skills), return urgently. Follow-up after referral.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for autism spectrum disorder. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

Domain 1: Data Gathering, Technical and Assessment Skills (Primary focus)

Scores well: Both ASD domains assessed. Key milestones checked (pointing, eye contact, pretend play, words). Regression screened. Hearing checked. Sibling comparison noted. Sensory features asked.

Costs marks: Not assessing both domains. Missing pointing and joint attention. Not checking regression. Not assessing hearing.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Appropriate referral to developmental team. Hearing test. Not diagnosing in primary care. Health visitor involvement. Follow-up plan.

Costs marks: Diagnosing ASD. No referral. Dismissing without assessment.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Taking maternal concern seriously. Framing referral positively (understanding, not labelling). Providing hope about early support. Addressing the emotional weight of the concern.

Costs marks: Dismissing. Being alarmist ('your child has autism'). Not acknowledging the mother's distress.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Diagnosing ASD in primary care. ASD diagnosis requires multidisciplinary specialist assessment. Candidates who say 'I think Lily has autism' without specialist assessment are diagnosing beyond their scope.
  2. Dismissing the concern. The mother has noticed specific features (reduced eye contact, limited pointing, insistence on routine) that are consistent with ASD screening criteria. Candidates who reassure without referring miss the opportunity for early intervention.
  3. Not checking for regression. Loss of previously acquired language or social skills in a toddler is a red flag for Rett syndrome and other neurodevelopmental conditions requiring urgent assessment.

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How should I structure the autism spectrum disorder history in this PLAB 2 station?

Parental concern about autism requires the candidate to take a structured developmental history focusing on social communication and restricted behaviours, while being sensitive about a diagnosis that carries significant emotional weight. Lily is 2 years 4 months, her mother Maureen is concerned about social interaction and repetitive behaviours. Open with: 'Maureen, tell me what you have noticed about Lily that concerns you.'

What are examiners marking in this autism spectrum disorder station?

Marks are won for: Both ASD domains assessed. Key milestones checked (pointing, eye contact, pretend play, words). Regression screened. Hearing checked. Sibling comparison noted. Marks are lost for: Not assessing both domains. Missing pointing and joint attention. Not checking regression. Not assessing hearing.

What is the most common mistake candidates make in this autism spectrum disorder station?

Diagnosing ASD in primary care. ASD diagnosis requires multidisciplinary specialist assessment. Candidates who say 'I think Lily has autism' without specialist assessment are diagnosing beyond their scope.

How do I prepare for this station if I have not managed autism spectrum disorder in clinical practice?

Structure beats experience here. Focus on proto-declarative pointing as a key milestone: pointing to share interest, not just to request. Work through the consultation approach above, then rehearse it aloud under the 8-minute time pressure so the structure holds up in the exam.

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