Autism Spectrum Disorder in a Rural Pakistani Child with a History of Early Excessive Screen Exposure: A Case Report

Abstract

Deficits in communication, social interaction, and behavior mark autism spectrum disorder (ASD). In low-resource settings, diagnostic delays and excessive early screening exposure complicate clinical profiles and access to therapy. We present a 7-year-old female from a rural community in Pakistan who presents with profound regression in speech, social interaction, and adaptive behavior. A child psychiatrist used DSM-5 criteria to diagnose ASD, which should be regarded as a working clinical impression. The child had no prior family history of neurodevelopmental disorders. Still, beginning in infancy, the patient had a history of extended unsupervised mobile screen exposure (3–5 hours/day of animated content). Symptoms included echolalia, idiosyncratic language, violence toward animals and peers without remorse, toileting difficulties, and emotional detachment. Carers reported fewer violent outbursts (from daily to 1-2/week) and better sleep (from 3-4 to 6-7 hours/night). Over the course of six months, risperidone (up to 1 mg/day) and carbamazepine (200 mg/day) partially improved aggression (from daily to 1-2 times/week) and sleep (from 3 to 7 hours/night), but social and language impairments remained. There were confounding variables, such as low socioeconomic position, and no standardized developmental assessments were conducted. This single case suggests that excessive early screen time may be associated with or modulate neurodevelopment. Due to the dearth of research and the absence of standardized ASD tests, it is not possible to conclude on screen time. This case illustrates gaps in ASD diagnosis and management and emphasizes the need for awareness campaigns, low-cost therapies, and culturally contextualized interventions.