Archive for the ‘Autism’ Category:
Is It Autism?
Autism diagnoses are skyrocketing, but are the incidences of autism really increasing? Are there really more autistic kids out there than there were before?
We don’t know for sure, but one major contribution seems to be the increasing recognition
of developmental problems in children by professionals like me. In
other words, is it possible that the increase in autism is simply an
increase in our diagnosis of the disorder? Yes.
The
single most frequent referral question I get, as a babyshrink, is, “is
this child autistic?” Often, I see a two-year-old who is head-banging,
language delayed, or performing repetitive behaviors. He may already
have a speech therapist or other specialist who worries about autism.
Or his parents may have seen Jenny McCarthy on Oprah, and say, “my kid
does that!”
The New Autism?
When
I went to grad school in the 1990s, we learned that Autism was a rare,
severe, and life-long disorder of communication and social relatedness.
These kids exhibited the most obvious signs of the disorder:
- Near complete retreat from communication with others
- Hand-flapping and other odd self-stimulatory behaviors
- Severe developmental delays and behavioral outbursts
These kids really could not be taught in any regular school setting. They needed support and help in daily living for a lifetime.
But
as time went on, clinicians started to see less severe forms of these
symptoms; we got better at recognizing them in their more subtle forms.
As more behavioral health-care professionals were trained, we had more
“eyes” looking for the problem. Parent advocacy and special education
laws increased pressure on the school systems to widen the array of
services for kids with less severe symptoms. Soon, I had parents and
teachers asking me to diagnose autism or a related disorder
so the child would qualify for intensive, expensive help that was only
available under the autism spectrum range of diagnoses. The
pressure is tremendous; here is a child who has communication and other
developmental delays. His parents have few resources. The school will
only pay if there is an autism diagnosis. Many clinicians admit that
they rationalize labeling the child “autistic” if it helps them get the
services they need.
So,
back to the typical 2-year-old head-banger referral. A toddler I saw
recently already had a new speech and language therapist, and an
occupational therapist. They were concerned about his lack of progress
in therapy. He had “lost speech”, meaning he no longer used the words
he once did. One psychologist had already labeled him “autistic”, after
spending just 60 minutes with him….in an office, not the child’s home,
where he is most comfortable and most himself. I found a shy little boy
who needed a lot of reassurance from his parents with me, a stranger,
in his home. But he was outgoing and comfortable with his siblings and
cousins on the playground. Later I found a buried note in the records
about ear infections and ask about it. Fast-forward two months; after
an ear/nose/throat and audiology consult, the child had ear tubes
placed to drain the accumulated fluid behind his eardrums. He
immediately began speaking meaningful words and his head-banging
decreased by 90%. Nobody is worried anymore about him; he is progressing beautifully and is on track to start preschool at age 3.
That child had painful, unremitting ear
infections that interfered with his hearing and language development,
and caused him to bang his head in an effort to deal with the pain. His
“lost speech” was a result of his shyness with the new speech
therapist, and his hearing difficulty. He never truly “lost” any
speech; he just was too shy to use his words with a new stranger, the
speech therapist! And he was diagnosed with autism, and that diagnosis
is “counted” in the statistics of the increasing “epidemic”.
I’m
not arguing with the possibility that the actual incidence of autism is
increasing. But I am not 100% convinced that that is taking place. And
I’m worried about the panic and alarm caused unnecessarily to parents.
I
worried that there are several other distinct disorders being thrown
together inappropriately with autism. Children with these disorders
deserve to have them studied and understood uniquely, and not just
lumped together with other disorders. In particular, there is a large
group of children with sensory and motor problems; for example, a baby
born with difficulty in tracking her vision. She cannot control her
eyes properly so she cannot make eye contact with her parents. She does
not learn to communicate well because she cannot make her eyes look
where she wants them to go. Her parents think she does not “want” to look at them to communicate. These days, when clinicians hear that a baby does not make eye contact, they immediately think “autism”. But
in this case, it is primarily a visual problem – one that, if
corrected, will completely eliminate all her delays and symptoms.
Check out the following illustration I found online…(if anyone knows the source, please email me! I have been trying to locate the author but cannot find any information.)
Figure
2. At the age of four months this baby girl turned her head away when
an adult tried to interact with her. This was interpreted as a sign of
infantile autism. Since two of the older three siblings had esotropia,
the infant was referred for an examination. She had normal looking
eyes, a refractive error of +1.0 I both eyes and no accommodation to
accommodative targets. Therefore +4.0 lenses were placed in front of
her eyes to give her a clear image on the retinas. The effect was immediate, the baby looked surprised and a few seconds later showed a normal social smile for the first time.
One
thing that health-care professionals seem to agree on is the fact that
“Autism” is really a general term for many different disorders, each
with different causes and outcomes. We need to work harder at
understanding all of the unique disorders that are now being lumped
together under one umbrella.
People are desperate to find a cause for autism. Childhood
vaccines protect children from some of the most horrible, deadly,
disfiguring, dangerous illnesses that routinely used to kill thousands.
Are there dangers with vaccines? Of course. As for all medical
treatments, you must weigh the potential risks with the potential
benefits. But this problem has been studied extensively by gold-ribbon teams worldwide. Their findings?
Not
even the older vaccines with thimerosol, a type of mercury. Mercury
poisoning by itself does not cause autism either. My kids have all
their vaccinations. I have relatives who are survivors of diphtheria
and other horrendous illnesses. They don’t want me to lose sight of the
misery that these illnesses inflict. And honestly, when other families
choose not to immunize their children, they put the safety of others at
risk; especially babies who are too young to have their full complement
of vaccines, and other children and adults with compromised immune
function.
Please
do not be misguided by the misinformation out there on vaccines. If you
have any questions, please review them carefully with your
pediatrician, who will probably agree with what I am saying.
True Autism Symptoms
Now, what does make me worry about autism in a child? Here
are the main things I look for when evaluating a baby or toddler.
(Remember: each child needs to be seen and thoroughly evaluated in
person, preferably in your home, by an experienced professional.) These are some things that should
trigger an evaluation, often to simultaneously include the evaluation
of developmental psychology, vision, hearing, genetics, neurology, and
occupational therapy/physical therapy specialists.
- No eye contact after four-to-five months
- Inability to comprehend any language by 12 months (comprehension of language is far more important than spoken language or speech)
- Lack of gesturing and pointing by 18 months
- Not turning to parents for emotional support/reassurance; exclusively preferring objects to people at any age
- Lack of imaginative play (make-believe/pretend games) by 18-24 months
There
are many other possible symptoms, such as lining up objects
compulsively, not responding to the child’s name being called, frequent
tantrums, making “strange” sounds, and the apparent “loss” of speech.
Often, these symptoms are problems, but are better explained by other
diagnoses, such as the visual/motor example above, or even complex
genetic disorders. And sometimes, these “problems” are simply normal expressions of toddlerhood!
So
the bottom line is this: if there are any concerns, get an evaluation
for your child sooner, rather than later, since time is of the essence.
But make sure you get a comprehensive, thorough evaluation that takes
all of the above into account. And if someone does use the word
“autism”, don’t panic. These days the word means many different things
to many different professionals, and often, the symptoms can be
completely ameliorated by the right therapy.
