Very early social skills training, ideally before school age, can make a big difference in a child’s development later on if they are autistic. However, many children are not receiving that vital assistance.
For many, the reason for this isn’t that they’re not receiving a diagnosis; rather, it’s that they’re receiving a different diagnostic first. Frequently, a pediatrician will diagnose ADHD in children as early as age 2 or 3. Alternatively, parents learn that their child has problems with sensory processing.
The autism isn’t then detected until social and academic pressures intensify. Before her son’s autism diagnosis, which came just short of turning five, one mother we know was diagnosed with both sensory processing disorder at age two and ADHD at age four.
In general, the preliminary evaluations and assessments are not always wrong. Since sensory processing issues are so prevalent in children with autism, it is thought that these difficulties constitute a sign of the illness. It is estimated that 30 to 40 percent of children with autism spectrum disorder also have ADHD.
But if medical professionals and parents stop there, they can postpone an autistic diagnosis. Furthermore, these kids aren’t receiving therapy that could have a far greater influence on their life, even while they are receiving treatment for ADHD or problems with their sensory processing.
Looking Beyond the Rapid Diagnosis
According to developmental pediatrician at Boston Children’s Hospital Amir Miodovnik, MD, “there is a tendency that once a patient has a diagnosis, because they have a number of symptoms that fit that diagnosis, clinicians can develop a bit of tunnel vision where some other findings might be overlooked.”
Lead researcher Dr. Miodovnik’s study of autistic children was published in Pediatrics. The study found that an initial diagnosis of ADHD was associated with an average three-year delay in the diagnosis of autism. Compared to children whose initial diagnosis was autism, those whose first diagnosis was ADHD were approximately thirty times more likely to be diagnosed with autism beyond the age of six.
The research validated the clinical expertise of Dr. Miodovnik. According to him, “we see a fair number of children who have previously been diagnosed with ADHD who we evaluate for autism spectrum disorder at an older age.”
Although early attention to sensory problems may benefit some children, senior clinician-researcher on autism spectrum disorders Catherine Lord, PhD, who is currently a professor and researcher at UCLA, has a similar concern that it may be delaying autism diagnosis. She notes, “We see children on the autism spectrum who have been receiving speech and language therapy and occupational therapy for years for sensory issues when they should have been receiving social skills instruction.”
Why do these early tests overlook autism?
According to Dr. Nash, there are several reasons why an autism diagnosis is not made based on these preliminary examinations of autism. Parents need to be aware of delays in order to prevent them.
- Parents and doctors tend to lean toward the diagnosis with the greatest prognosis. “It is understandable that before making a lifelong diagnosis of potential impairments, clinicians want to be certain.” Thus, the first course of action is frequently to treat what can be treated before reevaluating. For instance, “Let’s first treat this as ADHD and determine the extent to which the poor eye contact is caused by inattention.”
- Pediatricians are proponents of giving development a go. Children do develop at different rates, therefore that makes sense, according to Dr. Nash. Doctors, however, often seek to soothe parents, whose concerns and observations are frequently disregarded.
- It takes more than one brief office visit to diagnose autism. Dr. Nash notes that the length of the evaluation process is one reason pediatricians might miss autism. It takes 30 minutes to complete the usual assessment form, known as the Autism Diagnostic Observation Schedule, or ADOS. It should also be used in conjunction with a planned, multi-hour discussion with parents regarding past and present symptoms.
- When combined with autism, ADHD might resemble severe ADHD. “I frequently encounter the term ‘severe ADHD,’ and, based on my observations, it frequently corresponds with autism,” says Dr. Nash. When the impulsiveness and persevering attitude impairments are combined, “these kids can really get stuck in a loop and they cannot get off, and that can be very disruptive.”
- There is a broad spectrum of behaviors associated with autism. Because of their diversity and subtlety, the symptoms may be unnoticed by a non-specialist. A physician might assert, for instance, that a child cannot be on the spectrum since he made eye contact or smiled. However, Dr. Nash points out that the way in which eye contact is employed in social interactions is what defines autism. “Autistic children have a limited emotional spectrum. However, occasionally the effect is a constant smile. It could be a youngster grinning and looking. However, the therapist just sees a single instance; he might not see habits that parents are acquiring at home.
- Preschools are generally the first to notice sensory problems. Occupational therapists are on staff at many of them and are available to help with these kids. According to Dr. Nash, while sensory issues may contribute to a child’s unhappiness, they are frequently not the only issue. “The child loses out and wastes important time when sensory processing takes over as the main or exclusive focus.”
Dr. Nash advises parents of young children who think their kid might be autistic to make sure they have a thorough evaluation done by a specialist with training and experience in identifying autism spectrum disorders, such as a developmental pediatrician, neurologist, or pediatric psychiatrist.
As parents, you might wish to get a second opinion if you still believe the diagnosis is inaccurate or insufficient to explain the behavior you observe. While it may be tempting to embrace the efforts of loved ones, friends, and even medical professionals to avoid a diagnosis that might be frightening, it is not a smart idea to wait and see if autism is a possibility.
“As parents, empower yourselves,” advises Dr. Nash. “Speak up for your kid.”
