A - 57 Lack of Exposure or Cognitive Disorder? Using a Flexible, Process Oriented Neuropsychological Evaluation to Clarify Etiology of Social and Academic Weakness in a 13-Year-Old Boy

Abstract Objective Inadequate socialization and lack of academic exposure are known to impact developmental and academic milestones. Attention deficit hyperactivity disorder (ADHD) is a condition with high rates of global prevalence, and comorbidity with Autism Spectrum Disorder (ASD) and Specific Learning Disorder (SLD). We present the case of a 13-year old boy with social difficulties and academic concerns in the context of atypical academic experiences to demonstrate how a flexible and process-oriented approach distinguishes lack of appropriate academic and social exposures from underlying diagnoses. Methods Comprehensive neuropsychological evaluation with a focus on flexibility and process of a 13-year-old boy with a history of ADHD and hypotonia who was homeschooled and is currently in an online project-based program. Results Overall intellectual functioning was average. Deficits observed in mathematics and visuomotor skills (fine motor control). Variable performances noted in language, visuospatial, memory, executive functioning, and behavioral/emotional functioning (anxiety). Limit testing, documentation of patient process, and considering the patient’s prior exposure to academic material through robust clinical interview helped confirm the presence of ADHD, ASD, SLD (written expression and mathematics), and developmental coordination disorder (DCD). Conclusion This case highlights the challenges of distinguishing overlapping clinical and neuropsychological features of comorbid ADHD, ASD, SLD, and DCD in children with atypical social and academic exposures. It emphasizes how a process oriented neuropsychological approach differentiates overlapping features and clarifies diagnoses to tailor recommendations for maximized outcomes.