Unravelling High Functioning Autism in a Child with Comorbid Psychiatric Manifestations: A Case Report with Review of Literature

Abstract

Background: Autism Spectrum Disorder (ASD) without accompanying language or intellectual impairment, previously termed Asperger syndrome, is characterized by deficits in social communication, restricted interests, and behavioral rigidity. In highly verbal and intellectually gifted children, particularly girls, core autistic traits may be masked, leading to frequent misdiagnosis as primary mood, anxiety, or psychotic disorders. Such diagnostic delays can adversely affect clinical outcomes. Case Presentation: We report the case of an 8-year-old girl who presented with escalating aggression, obsessive behaviors, social withdrawal, sensory hypersensitivity, and self-injurious behavior. Over a two-year period, she received multiple psychiatric diagnoses, including schizophrenia and bipolar disorder, and was treated with antipsychotics and mood stabilizers, with worsening symptoms. A detailed re-evaluation focusing on early social developmental milestones, sensory profile, and symptom clustering led to the diagnosis of high-functioning ASD with comorbid depression and obsessive-compulsive disorder. Multimodal intervention including pharmacotherapy, cognitive-behavioral therapy, structured environmental modifications at home and school, and parental education resulted in marked clinical improvement. Quality of life improved significantly over one year, as measured using a standardized objective assessment tool. Conclusion: This case underscores the importance of careful assessment of social developmental milestones and interpretation of behavioral symptoms as an interrelated cluster rather than isolated psychiatric entities. Early recognition of high-functioning ASD, especially in cognitively advanced children, enables appropriate interventions and significantly improves long-term outcomes.