Abstract Objective This case illustrates a diagnostically complex profile of Autism Spectrum Disorder (ASD) with accompanying language impairment in a bilingual child. It contributes to existing literature by demonstrating how co-occurring neurodevelopmental, neurological, and sociocultural factors—including delayed caregiver reporting, bilingual exposure, and limited early developmental history—affect diagnostic clarity and neuropsychological functioning. The case underscores the importance of culturally informed assessment in ASD evaluations. Method A 12-year-old left-handed male with a history of ASD, Mixed Receptive-Expressive Language Disorder, and febrile seizure(s) was referred for comprehensive neuropsychological evaluation after immigrating from the Philippines to the United States in 2023. His early development occurred while separated from primary caregivers, limiting reliable developmental history. His first language was Tagalog, though his current instruction and academic exposure are exclusively in English. Cultural-linguistic considerations guided the decision to administer testing in English. Assessment included WISC-V, WJ-IV, NEPSY-II, Autism Diagnostic Interview–Revised, Vineland-III, and BRIEF-2. Results Findings revealed a marked verbal-nonverbal split (VCI = 2nd percentile; Block Design = 91st percentile), with severely impaired reading comprehension ( 1st percentile). Social cognition deficits were pronounced, with impaired Theory of Mind ( 2nd percentile) and Affect Recognition ( 1st percentile). Language output included idiosyncratic, perseverative speech. Executive functioning was mixed, with superior inhibition but impaired initiation and abstract reasoning. Conclusion This case highlights the intersection of autism, language disorder, early caregiving disruption, and cultural-linguistic complexity. It reinforces the necessity of culturally responsive, multimodal neuropsychological assessment to capture nuanced brain–behavior relationships in globally mobile populations.
Gabrielle Nabity (Fri,) studied this question.