What's autism, what's not
One in 68 children has an autism-spectrum disorder (ASD). When screening children, however, physicians must be aware that many other developmental disorders occur more commonly, Susan Hyman, MD, FAAP, told attendees of her session “It’s not always autism,” presented at the American Academy of Pediatrics 2016 National Conference and Exhibition.
The Modified Checklist for Autism in Toddlers (M-CHAT) is an excellent tool. Among children who screen positive on this test, 95% ultimately are diagnosed with some developmental disorder; about 45% will be diagnosed with autism.
In Hyman’s referral-based practice, a fairly large percentage of children sent for evaluation of autism walk away with other diagnoses. Very commonly, family members or caregivers are looking for a diagnosis to accurately describe the issues their child is having, and arrange for appropriate services.
In such situations, attention-deficit/hyperactivity disorder (ADHD) ranks among the most common nonautism disorders physicians see. Hyman noted that ADHD might look like autism because ADHD symptoms can include inattentiveness (generally, and to social language and cues), impulsiveness, apparently tangential speech, and behavioral dysregulation. These children may explode for no apparent reason, and have selective attention to sensory stimuli. All these behaviors may be seen in autism, but for different reasons. Children with ADHD have social awareness; their primary deficit is attention. How their symptoms differ from autism may not be apparent until one steps back and considers the reasons behind them.
When a child tests positive on a screen such as the M-CHAT, pediatricians must refer, not defer, Hyman said. A positive screen is not something to sit on. It means something is going on—the child needs developmental evaluation, through early intervention under the direction of a specialist, to consider the potential for an autism diagnosis. The primary care provider then will get feedback from these evaluations, and must provide the medical home for the patient.
Pediatricians are getting increasingly better at screening and identifying developmental disorders; their awareness for developmental differences is elevated. However, they need to do even better regarding timely referrals for evaluation. Often, there's a disconnect or delay in screening and evaluation, and many of these children are medically underserved to begin with. Early treatment has documented benefit. Outcome is improved by treatment that is early and intense, and that includes the family.