Parental anxiety is an important tool for the diagnosis of pediatric disorders. Without a certain amount of hand-wringing over developmental delays, for instance, parents might miss symptoms connected to conditions like Autism Spectrum Disorder (ASD) and lose a chance for early intervention. But parents can also become hyper-focused. If all a parent has is a loose diagnostic understanding of ASD, then everything is going to look like ASD.
“Diagnoses evolve,” says Dr. Andrew Adesman Chief of Developmental & Behavioral Pediatrics at the Steven & Alexandra Cohen Children’s Medical Center of New York. He admits the evolution may be officially slow. After all, it took 16 years for ASD to become officially recognized in the 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, practitioners who work with children every day a quicker to recognize emerging conditions. “Sometimes parents make the mistake of focusing on one symptom that might lead them to one diagnosis, not considering what other clinical criteria go into making a given diagnosis,” Adesman says.
So, before parents latch onto the idea that their kid is “on the spectrum” it’s important for them to consider what are called diagnostic mimics. There are several conditions that could cause a child’s ASD-like symptoms but are unrelated to the disorder.
The most commonly discussed symptoms of ASD are linked to social behavior—or the child’s ability to simply be present and engaged with a parent. But social behaviors can be affected when a baby is experiencing difficulty with their senses.
Normally developing babies, for instance, should be able to meet and follow a parent’s gaze. However, if an infant’s vision isn’t developing properly, their interaction with parents could be muted simply because they are having difficulty seeing them. That’s why vision tests should be used to rule out eye-problems before a diagnosis of ASD.
“Children who have hearing problems can have language delays and language delays can suggest an autism spectrum disorder,” notes Adesman. But he stresses that the language delays won’t necessarily occur unless there is significant issues with hearing in both ears. So a child with a recurring ear infection in a single ear is unlikely to develop a delay in language.
Also, Adesman notes that children with hearing problems will often be very visually engaged. “Children with an Autism spectrum disorder typically are going to have either gaze aversion or may not be as visually engaged,” he explains.
Sensory Processing Disorder
Children with ASD are typically thought to be sensitive to certain sensory inputs, though it should be said that many aren’t. However, there are children who are not on the spectrum but are still highly sensitive to sound and touch. Something like a twisted sock or a tag in their shirt might set them off.
There is an emerging condition recognized by many physical therapists called Sensory Processing Disorder. That said, it isn’t officially recognized in mainstream diagnostic manuals yet.
General Intellectual Disabilities
For every child diagnosed with ASD there are one to two diagnosed with another form of intellectual disability such as Fetal Alcohol Syndrome or Down’s Syndrome. The fact is that those general intellectual disabilities are far more common than ASD and can often share symptoms.
“So for children presenting very early on for language delay, something you have to think about is a language disorder,” explains Adesman. “Another thing you have to think about is an intellectual disability. The third thing you have to think about is ASD.”
Some older children may develop repetitive behaviors or become socially awkward and withdrawn. These are symptoms also linked to psychological disorders like Obsessive Compulsive Disorder or Anxiety disorders.
In the end, parents need to be particularly savvy when navigating information related to ASD, Adesman says. “Parents can and should self-educate,” he encourages. “But there’s an important place for families to talk to their pediatrician.”
He also notes that every parent is entitled to a free evaluation if they are concerned about their child. But stresses, “There’s no single discrete feature that rules in or rules out a diagnosis of ASD.”