With increasing frequency lately, this medical practice evaluates another child who displays a combination of signs and symptoms that can best be explained by the term, “Escaping Autism.”
There appears to be some common connection involving the parents’ chief concerns, physical examination findings, laboratory results, response to treatment and residual behaviors. It is something that you just can’t put your finger on.
There may be sensory difficulties, problems with focus, heightened anxiety, ADHDAttention deficit - hyperactivity disorder, ODDOppositional Defiance Disorder - A pattern of negativistic, hostile, and defiant behavior, G-IGastro-intestinal (stomach, small intestine; large bowel) issues (from GERDGastroesophageal reflux disease-a condition in which the stomach contents leak backwards from the stomach into the esophagus to constipation), allergies (from asthma to eczema), repeated ear infections, low muscle tone, poor sleep, very restricted diet, or decreased eye contact – in some combination that doesn’t seem to be supported as a separate diagnosis in the present scientific literature.
The condition is not “classical” autism because the patient lacks symptoms in one or all of the 3 key global domains (social isolation, repetitive movements or restricted interests, and the inability to communicate). Why not call it PDD-NOSPervasive (or Persistent) Developmental Delay, not otherwise specified? Actually, such a diagnostic assignment probably represents the present, most accurate classification. However, there are so many conditions included in that “waste-basket” category; it begs to be picked apart as more precise situations become apparent.
“Escaping Autism” represents a more simple, unifying proposal (Occam’s Razor). Such a diagnosis adds to the modern pediatricians’ toolbox by documenting identifiable signs and symptoms that may be amenable to effective medical interventions. This is a newly described association.
A “Spectrum” of difficulties that are now considered separate childhood disorders may also be viewed as a unified picture of multi-system involvement. This clinically distinct syndrome may change and evolve as the interplay of behavioral and/or functional changes mature in the individual patient.
Some good news is that, as in other medical disorders, the less severe the presentation, the smoother the clinical course. After all, mildly asthmatic patients who can be treated with inhalants and kept out of the hospital are a lot easier to manage than those requiring frequent therapeutic alterations. The professional workup should include routine blood tests and more, depending on the symptoms and practitioners’ findings. Appropriate interventions, based on clinical and laboratory data, would follow.
Such information is not well-accepted in the conventional world. There might be a great deal of pushback from allergists, neurologists and other pediatric subspecialties. Negative initial responses may be misinterpreted as a sign that treatments are not proceeding on the correct path. Should there be a rocky course to recovery, families are less likely to remain patient, especially in a ‘higher functioning’, non-autistic individual. Plus, there is the chance that the child will continue to improve, with or without intervention.
Could these patients who have “Escaped Autism” represent the tip of the iceberg involving an emerging additional developmental diagnosis? Are such children the next “canaries in the coal mine“? Considering that ASDAutism spectrum disorder may represent the perfect storm, comprised of modern environmental stressors acting upon genetically susceptible individuals, one more genetic variance, or one more toxin, could result in additional parents who find their offspring have gone ‘over the fence’, so to speak.
As far as taxonomy goes, a clearer nomenclature will unfold as increased numbers of children demonstrate this cluster of symptoms and successful treatments come to light.
One of our patients has suggested that we call it NAUTISM!