I was performing a mental status examination or mental state examination (MSE) on a 9-year-old male patient with a history of Autism Disorder. The kid was doing phenomenal in this examination until I asked him to subtract 7 from 100 (this is called serial sevens, it assesses the mental state and possibly cognition), he couldn’t do it at all. I gave him around 3 minutes and he just gave up. He was giving me different answers: 107, 117 and so on. This was definitely not normal for his age.
After discussing the results with my attending, he instructed me to ask it in a different way. The next day, I decided to interview the patient again and ask him about his day and what things that are bothering him possibly. After some times passes by during the interview:
I asked him: “What is your favorite fruit?”
The kid replied: “Apples!”
Then I said: “Imagine you are an apple dealer and now I am willing to pay you $1/apple.” The kid was super excited as I can see his smile and he was concentrating a lot more.
I told him: “Would you like to sell me some?”
He answered: “Yes.”
I said: “Alright. Well you have 100 apples now.” He replied: “Wow, I have so many apples!”
I said: “I want 7 apples, please. How much would that be and how many do you have left?”
He replied: “$7 and I will have 93 apples.”
I was shocked. He was able to give me the answer every time I asked to buy 7 more apples!
