Your two-year-old isn’t making eye contact with others but will happily stare at the television for an hour. Is it just normal toddler behavior or could it be a sign of autism?
Some pediatricians used to wait until the pre-school years to diagnose autism, but the complex spectrum of disorders is being diagnosed and treated earlier. The American Academy of Pediatrics last year recommended testing children as early as age two for signs of autism.
“The earlier the intervention, the better,” says Neil Pollack, executive director of Anderson Center for Autism in Staatsburg. “It’s best to look at the actual symptoms being displayed and treat them, whether or not there is a diagnosis of autism.”
Kathy Knee of Highland has always believed in earlier testing and said she saw warning signs in her son Ryan since birth. “I could never put my finger on what it was,” says Knee. “He was a terrible sleeper, he didn’t reach the typical milestones on time, he didn’t babble.”
Ryan has seen several doctors and received a variety of diagnoses – pervasive developmental disorder, in need of a low-sugar diet, and told to just wait for improvement. The most telling diagnosis was Asperger Syndrome, which is on the spectrum of autism disorders, and Attention Deficit Hyperactivity Disorder. While it is possible for misdiagnosis at an early age, a pediatrician might recommend seeing a pediatric neurologist.
“This is a spectrum of diseases that range from very mild to very severe,” says Dr. Herschel Lessin, medical director of Children’s Medical Group, which screens patients at 18 months and again at their 2-year physical. “It is important to get a diagnosis that’s solid enough and that you feel comfortable with.”
The spectrum, says Lessin “is poorly understood and often underdiagnosed.” Kids who were once considered “quirky” might now be diagnosed with Asperger’s, or an autistic child might be diagnosed as having a speech or other delay. The screening done by doctors is designed to pick up more than it misses so no children fall through the cracks.
“The earlier they’re treated,” he adds, “the better, because it’s proven that early intervention works.”
There are different types of screening programs used throughout the country. One test, the M-CHAT (Modified Checklist for Autism in Toddlers) is designed for children 16 to 30 months old. Parents are asked questions such as “Did you ever think your child was deaf?” and “Does your child take an interest in other children?” However, it is possible for false positives to occur.
A comprehensive evaluation might include a psychologist, neurologist, psychiatrist, speech therapist, and others who diagnose children with Autism Spectrum Disorders or ASDs. Neurological, cognitive, language, and hearing tests may be done as well. If not done through health insurance, New York’s Early Intervention Program provides testing and treatment.
Ryan, now 8, began receiving services from the Early Intervention Program when he was 17 months old. By the time he was three, he was getting speech, occupational, and physical therapies. Knee says her pediatrician advocated early testing and was very supportive in the family receiving services.
Such programs are provided free by the state and administered at the county level until age 3, when the school district takes over. Most health insurances will pay for standard tests and treatment, but nothing experimental or too specialized such as hyperbaric oxygen treatment (a controversial practice aiming to increase oxygen intake to the brain in an attempt to improve autism symptoms) or nutrition treatment (which suggests improvement by adding or avoiding certain foods).
The Anderson Center this year started a consulting practice to meet the “incredible need for a diverse amount of services in the area,” Pollack said. Parents, schools, and other agencies in the Hudson Valley and beyond have been turning to the center for the consulting service.
The Center gets a lot of referrals and calls for information. With the consulting service, it hopes to help more children stay in school and receive treatment there using the programs created at Anderson.
Specialists – developmental pediatricians, psychiatrists, and neurologists – are the best option after a child has been seen by their pediatrician. “We can’t spend hours with each child doing tests,” says Lessin. “It just can’t be done.” He also warns parents to be wary of any person or program that promises an easy fix or wonder cure.
“There are plenty of therapies that help,” says Lessin. “But, if someone tells you they have the exclusive answer that everyone else has been surpressing, I would run away. There’s a lot of snake oil out there so you have to be careful.”
Parents must also understand that screening is subjective and all doctors are different. Even a misdiagnosis of autism can be a good thing in the long run. If your child isn’t reaching regular milestones, it could be a sign of a physical delay that would benefit from Early Intervention. For many children, autism symptoms improve with treatment and with age.
“A child with autism could be institutionalized or become and engineer,” says Lessin. “These kids need advocates. They need people to fight for them.”
Liz Consavage Vilato is a freelance writer and mom of two living in Wappingers Falls.
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