A 7-year-old boy with no significant abnormal medical history presents to the emergency department of a tertiary care children’s hospital with subacute progressive increase in unusual behaviors. For the past several weeks, his parents have noted instances during conversations when he pauses for a few seconds after being spoken to before asking, “What?” Usually after the words are repeated to him, he responds appropriately, although he has also sometimes had strange responses to questions; once when asked, “Can you get that shoe?” he appeared confused then replied, “There are no cows in the house.” The instances occurred only a few times daily at first but have progressively increased in frequency to multiple times per conversation. When they have been pointed out to him, he becomes defensive and blames them on his parents not speaking loudly enough or the room being too loud. Otherwise, he has behaved and interacted normally. His...

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