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I’ve written before about the confusion and difficulty around the diagnosis of Autism in young children (before the age of 3).

My regular readers know that I’m a strong proponent of Early Intervention screening, and also of early intervention therapy services. This means having your local Child Development center see your child BEFORE the age of three, should you have any concerns about her development, social interaction, or communication skills.

But you also know that I am loathe to jump on the autism-hysteria bandwagon. I worry that there are many other problems that are being missed because we’re jumping to the Autism diagnosis too quickly. Issues of sensory, cognitive, medical, environmental, or even genetic problems can be missed when a diagnosis is made too quickly. Also, the range of child development is so wide, that what can SEEM abnormal may not be. And I blame my field; many of us are so concerned about the number of developmentally delayed children out there, and so few of us are adequately trained to truly evaluate for Autism in the early years, that too may children are mistakenly diagnosed as Autistic. And then their REAL problems go undetected — and untreated.

If I had a million bucks (or ten) I’d start a training foundation centered on the intensive training of Early Intervention clinicians in the detection and treatment of Autism-related conditions — and other problems that might SEEM like Autism, but are NOT. We need a nation-wide (heck, world-wide) training initiative so that psychologists, pediatricians, speech and language therapists, occupational therapists, special instruction teachers — indeed the whole range of Early Intervention professionals — can get the advanced training we all need in this very specialized area.

In the meantime, you can read this very interesting article at Time.com summarizing some of the newest research on signs of Autism in the very young infant. It also helps to explain why this is truly a very difficult disorder to diagnose in the early years. And if you missed it, there’s also a link to a popular post of mine on the diagnosis of Autism.

Click here for the Time.com article, and

click here for my own article on Autism.

Aloha,

Dr. Heather
The BabyShrink

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.

Digging Deeper: When Autism Diagnoses Are Misguided

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.

Misdiagnosed?

I am 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.

A Word About Vaccines

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? Vaccines do not cause autism. 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, polio and other horrendous illnesses. They don’t want me to lose sight of the misery (and death) 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 of age;
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, family stresses and problems, 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.

Do you have stories to share about the diagnosis of your child’s developmental delays?