Mr and Mrs Floyd, the parents of Leroy, an 8-year-old child with Asperger syndrome, recently moved from out of state and contacted Dr Stonehill, a primary care pediatrician with experience in developmental-behavioral problems. Dr Stonehill planned for an extended initial office visit. Leroy demonstrated many of the behaviors characteristic of children with Asperger syndrome. He avoided eye contact and was preoccupied with his Yu-Gi-Oh cards. He startled easily and was impulsive and oppositional, particularly during his physical examination. Mrs Floyd informed Dr Stonehill that Leroy had been prescribed a “ton of meds, and none had worked well.” She also brought a long list of specialists whom she had consulted and informed Dr Stonehill that each one had failed to be of any help. She seemed very needy, and initially she responded well to Dr Stonehill's patient and supportive manner. At the end of the visit, she expressed extreme gratitude for...

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