Ten Things All Pediatricians Should Know About Autism

In the course of the detailed history that our parents provide concerning their infant’s development, I am (too) often struck by the lack of accurate advice offered by the former pediatrician. Yeah, the family no longer sees that doctor.

It probably shouldn’t come as such a surprise. ASD is THE major childhood epidemic of the 21st century, and the latest issue of our most respected scientific journal did not have a single article dedicated to autism. And, if you think that doctors merely used to “call it something else,” you have to explain why the incidence of “Mental Retardation” never approached 1/68 children.

It’s not just speech and language delay if a) the kid loses previously acquired words
and b) another symptom is present.

Other includes motor weakness, such as late sitting or walking, unusual crawl and decreased muscle tone. Signs may include torticollis (that starts after birth), plagiocephaly (infants paced on their back who don’t turn), GERD (weakness of the gstro-esophageal junction or diaphragmatic muscle), continuous drooling or poor chewing (oral musculature) leading to textural symptoms and restricted diet.

Other includes unusual behaviors. Pediatricians need to be concerned about extreme tantrums that proceed to self injurious behaviors. Head banging, continuous rocking, and chronic sleep problems should be investigated as red flags for ASD.

Other includes a paucity of social interaction as manifest by poor eye contact (especially loss of this skill), not turning to voices, and rejecting cuddling.

Other includes medical problems. Frequent infections, especially accompanied by numerous courses of antibiotics, may be a sign of impending regression; or conduct that may trigger it. Skin rashes diagnosed as eczema, significant environmental or food allergies, and asthma are often additional diagnoses, noted in our patients. Doctors should inquire about unusual stooling (constipation or/and diarrhea), including consistency or color changes.

Medical professionals who proclaim, “We have to wait to give you a diagnosis” are ignorant at best and detrimental at worst. There is no need to wait to be sure of the diagnosis. It is imperative to intervene at the earliest possible time, when socialization and communication are at the most formative stage.

Don’t wait to get a neurologist to confirm the diagnosis. True, they may provide important additional insights, especially if a seizure or other condition is suspected. Also, insurance companies usually demand their professional opinion to obtain certain tests, such as MRI, and referrals for therapy. Otherwise, they are generally of little assistance as far as elucidating the problem or offering useful advice.

There could be a need to see a genetics doctor. A number of ASD patients have major or minor identifiable genetic variations. One doctor told our Mom, “Well, if you aren’t having any more children, it really isn’t necessary.” So, if, in the next few years, a treatment becomes available for that specific condition – wouldn’t the parents want to know? And, if there are other patients out there with the same problem, the family might consider becoming involved in research or wish to join a support group. What happened to scientific curiosity and accurate diagnostic criteria?

The presence of one or two non-autistic behaviors does not rule out Spectrum Disorder.
Successful interactions are important clues about what pathways are functioning properly.

“He’s a boy, they talk later,” “She’s the youngest,” “The parents are spoiling the child,” “You speak two languages,” and “Don’t worry” are excuses for the previous century.

Children who aren’t speaking by the middle of their second year deserve the pediatrician’s immediate attention to ascertain whether there are other comorbid conditions, and investigate pertinent intervention(s). Parents who continue to have doubts should seek another physician, especially one who specializes in childhood development.

Regardless of an “official” diagnosis, initiate appropriate therapies. Stat.

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Brian D. Udell MD
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