Is It Time to Change the Diagnosis of Autism?

In the heels of new government data last week, indicating 1 in 88 children have autism, there may be a potential change in how we diagnose autism looming in the not too distant future. And although I do understand the need to better clarify autism and those who are on thespectrum, I certainly hear the concerns being raised by those who want to leave the current system in place.

You see, when I first finished residency in the early part of last decade, I thought I had a great understanding of the diagnosis of autism. But when I began my career as a general pediatrician, I soon began to realize that the diagnosis of autism was so very vast, including mild to severe symptoms. And while there was little confusion when it came to diagnosing autistic children with more severe symptoms, things were not so easy with children who had mild symptoms. I initially found parents more reluctant in giving their child a diagnosis of autism because of the potential social taboo attached to having the diagnosis. Often, I would refer to my developmental pediatric colleagues to help clarify the diagnosis and identify appropriate developmental services for their child…often provided by the state.

And so over the past decade, I’ve noticed a change in mentality where parents have become more open to the diagnosis, as they realized that early intervention (even with children who had mild symptoms,) was so very helpful to the overall developmental growth of their children. And getting the official diagnosis would allow for services to be provided by the state.

And so this brings us to current day where making the diagnosis of autism has become so stretched that the American Psychiatric Association has proposed changes in how we diagnose autism.

Bearing in mind there is no definitive test for autism, some of these proposed changes include:

- A new “autism spectrum disorder” category. It would be used to describe symptoms that appear before age 3 and would include those who currently are considered to be severe cases, as well as 2 high-functioning variations. It would require 3 types of communication problems (including minimal to no conversation and poor social skills,) and at least 2 repetitive behaviors or unusual interests such as arm/hand-flapping, tiptoe-walking, and obsession with quirky topics.

- Asperger’s disorder and pervasive developmental disorder not otherwise specified (PDD-NOS, a diagnosis often given to children with mild symptoms) would be no longer, but their symptoms would possibly fit under the autism spectrum disorder category.

- A new category labeled as “social communication disorder” which would include children who have difficulty relating to others and have problems reading facial expressions and body language.

So with these changes, some experts are concerned as many as 40% of those currently diagnosed with autism will no longer fit the criteria, which would mean no services provided by the state.

And while I agree there needs to be better clarification of how we define autism, I am as a huge a proponent of early intervention even in the most mild of cases. Because the mind set should always be to maximize the potential of our children and early intervention clearly does that. Ultimately, we must tread very carefully here, as we must consider the full ramifications in changing how we diagnose autism.

Any thoughts?

- Dr. Jeremy

For more blogs by Dr. Jeremy F. Shaprio, or community support groups, visit DailyStrength.org.

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