Early Intervention Is Key
It can be stressful enough to have a new baby. Then someone shares some stats about rising autism rates (now estimated at 1 in 59, according to the Centers for Disease Control and Prevention), and the tired new parent is suddenly faced with anxiety.
Take a deep breath. Ask a professional.
Dr. James Phalen, a specialist in developmental pediatrics at University Health, said there are specific recommended steps to diagnosing autism spectrum disorder, or ASD. In the case of ASD, early diagnosis and intervention (18 to 24 months) is best to help the child reach their maximum potential.
It is also possible that a child might have been misdiagnosed.
Misdiagnosis Is Common
“I’ve had a lot of kids come to me that have had inpatient psychiatric treatment,” Phalen said. “I tell parents I’m the something-else-ologist.”
These children may have been treated for any number of different disorders, he said, including anxiety, depression, bipolar disorder and attention-deficit/hyperactivity disorder (ADHD). “I’ve had four-year-olds, I’ve had 24-year-olds come to me,” he said. “The parents are exhausted by the time they get here. They’ve been through the wringer.”
Autism Makes Communication Difficult
“The key thing that sets ASD apart is the difficulty in making social connections,” Phalen said.
ASD is defined by the CDC as a developmental disorder that can cause significant social, communication and behavioral challenges. But the learning and communication abilities of people with autism can vary greatly, as can their symptoms, adding to the confusion. It isn’t certain what causes autism, according to the CDC, but genetic and environmental factors can contribute to the risk.
“The key thing that sets ASD apart is the difficulty in making social connections,” Phalen said.
Pinning Down the Real Numbers
Parents may interpret some symptoms, like obsessive-compulsive or repetitive behaviors, as signs of autism, Phalen said, but those can also point to other problems.
Pediatricians were not previously trained to recognize the signs of autism, he said, so they’ve only begun in recent years to know what to look for. And in some cases, as more autism is diagnosed, the diagnosis of intellectual disability has declined.
“Some studies show that patients who were previously diagnosed as having an intellectual disability are now being diagnosed with an autism spectrum disorder,” Phalen said.
There have also been changes in the way autism is defined – the 2013 update of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) rolled Asperger syndrome and some other disorders under the umbrella diagnosis of ASD.
Screening for ASD
If parents are concerned that their child has ASD, they should schedule an appointment with the child’s primary care provider. If the child is 18 to 24 months old, the American Academy of Pediatrics recommends that the doctor use a checklist called the Modified Checklist for Autism, Revised.
If the child doesn’t pass the screener, the doctor then administers a follow-up interview. Then the child is referred to audiology, speech therapy and a qualified ASD diagnostician – who might be a developmental-behavioral pediatrician or a clinical psychologist.
Any parent who questions their child’s diagnosis of ASD (or lack thereof) can seek a second opinion, Phalen said.
Up to 20% of children diagnosed with ASD before age 5 will no longer meet criteria when re-evaluated at a later date, he said. And then there are those who are simply misdiagnosed.
Parents should take a deep breath and not be afraid to ask for a second opinion.
While you wait: interventions parents can use
- For children in Texas who are younger than 36 months old, call Early Childhood Intervention Services (ECI) for speech and language evaluation. Do not allow any screen time (i.e., TV, phone, tablet).
- For children who are 36 months and older, contact the local public school district for an evaluation. Limit screen time to 1 hour per day, maximum.
- For all children, see an audiologist to evaluate for hearing loss, and read to them.
