Dear Dr. Gnaulati:
We are writing in response to your article, “1 in 68 Children Now Has a Diagnosis of Autism Spectrum Disorder-Why?” (The Atlantic.com. April 11, 2014). Thank you for reviewing recent research in the field on screening processes, such as the pitch of infant cries and the interest in geometric shapes vs. social images.
You raise an important issue of misdiagnosis or overdiagnosis in your article. More specifically, you bring up the concern of practitioners’ frequent difficulty ruling out other factors when making a diagnosis of an autism spectrum disorder— in particular, the “slow-to-mature toddler.” We, too, would like to see research that could help practitioners develop better screening procedures. The lack of education of pediatricians, in typical child development, that you pointed out is alarming. Educating practitioners in typical development is essential in being able to differentiate between the autism spectrum disorders and the “slow-to-mature toddler.”
That being said, we cannot lose sight of the fact that for a child with autism, early diagnosis is critical. Until research demonstrates a method for discriminating between this “slow-to-mature toddler” and a child on the mild end of the autism spectrum, we have to ensure that any child with a suspected autism spectrum disorder receives the services that he or she needs.
You did also stress the fact that early diagnosis is critical, but it is equally important to point out why. Early diagnosis enables children to gain access to scientifically validated treatments, such as applied behavior analysis (ABA). The science of applied behavior analysis has over 40 years of research to support its effectiveness, and it has been recommended by various state and federal agencies, including the New York State Department of Health and the U.S. Surgeon General. Although, as you point out, the literature indicates that over 30% of children that have a diagnosis at age two no longer have a diagnosis at age four (Sutera et at., 2007), this cannot be blamed solely on misdiagnosis. Research also supports that early and intensive ABA intervention can decrease or eliminate some of the characteristics of an autism spectrum disorder (Remington et al., 2007), therefore possibly accounting for a portion of the aforementioned children. For this reason, we want to make it clear that the “wait and see approach” should never be an option. Children and families simply cannot afford to lose valuable time that could otherwise be spent making progress.
Ensuring that the professionals who diagnose autism spectrum disorders have specialized training in the field, as well as knowledge of typical child development, is key. Hopefully, your article will help to generate awareness of early diagnosis and continued research into diagnostic practices. Thank you for addressing such an important topic.
Anya K. Silver, MA, BCBA and Leigh Broughan, MA, BCBA
Association for Science in Autism Treatment
References
Remington, B., Hastings, R.P., Kovshoff, H., Degli Espinosa, F., Jahr, E., Brown, T., et al. (2007). Early intensive behavioral intervention: Outcomes for children with autism and their parents after two years. American Journal of Mental Retardation, 112, 418-438.
Sutera, S., Pandey, J., Esser, E.L., Rosenthal, M.A., Wilson, L.B., Barton, M., et al. (2007). Predictors for optimal outcome in toddlers diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 98-107.
