Where a Child Is Tested May Affect Autism
MONDAY, Nov. 7 (HealthDay News) -- Whether health professionals
diagnose a child with autism or with a milder form of the
neurodevelopmental disorder such as Asperger syndrome isn't
determined only by the child's symptoms, but by where the child is
assessed, a new study finds.
Researchers found wide variability at autism centers across the
nation in the criteria health professionals used to determine
whether a child should be diagnosed with "autistic disorder" or
instead receive a diagnosis of a subtype of autism, including
pervasive developmental disorder-not otherwise specified (PDD-NOS)
and Asperger syndrome.
The study authors said the findings support the growing movement
among some autism experts to do away with distinctions such as
Asperger and instead put everyone who meets certain criteria under
the same umbrella, "autism spectrum disorder."
In the study, researchers collected data on about 2,100 children
aged 4 to 18 who met the criteria for an autism spectrum disorder
and had been seen at one of 12 university-based autism centers
across the United States. The children had all undergone a battery
of tests commonly used to measure language, thinking and
communications skills, and behavior. A psychologist, psychiatrist
or other health professional with autism expertise used the results
of the tests and an examination to make the final diagnosis.
At one site, every child was diagnosed with autism; no child was
diagnosed with Asperger or PDD-NOS. Conversely, another site
labeled about 40 percent of kids as having Asperger and 40 percent
with PDD-NOS, leaving only 20 percent with autism.
The reason for the inconsistency was that each site appeared to
be using its own cutoffs and criteria for autism versus Asperger
and PDD-NOS. For example, at one site, kids with an IQ of over 70
were given an Asperger diagnosis, while at another site, kids had
to have an IQ of 115 to be given an Asperger diagnosis, said lead
study author Catherine Lord, director of the Institute for Brain
Development at Weill Cornell Medical College and New
For the 61 percent of children with severe language,
communications and social deficits, and clearly repetitive behavior
-- all classic signs of autism -- there was good consistency among
the various centers in the autism diagnosis, according to the
report in the Nov. 7 online issue of the
Archives of General Psychiatry.
But for the 39 percent of children with milder problems, there
were large inconsistencies in whether the child was labeled with
autism, Asperger or PDD-NOS, the investigators found.
"The second most important predictor of which diagnosis the clinician made was where they worked, not any characteristic of the child, which is not good," said Lord.
Geraldine Dawson, chief science officer for Autism Speaks,
agreed that it may be time do away with diagnosing specific autism
subtypes and instead use the broader, and more reliable, autism
"Given the subtle distinctions among the subtypes of autism spectrum disorder, it is not surprising that clinicians were not consistent in how they applied these diagnoses," Dawson said. "In the future, it is likely that we will no longer attempt to classify individuals in the autism spectrum into different subtypes."
Furthermore, whether a child is diagnosed with Asperger or
autism doesn't change the treatment.
There are several possible reasons for the discrepancies among
autism centers. Parents may want to hear that their child has
Asperger rather than autism, and health professionals may be
influenced by that, Lord said.
On the other hand, in some regions, kids can only get certain
services if they have autism, so those centers may apply that term
Generally speaking, children with significant impairments in
language, communications and social skills, who exhibit repetitive
behaviors, and who have intellectual disabilities are diagnosed
Children who have some of the characteristics of autism, such as
language delays and social problems, but who have only very subtle
or not obvious repetitive behaviors, may be diagnosed with PDD-NOS.
And those who have some characteristics of autism but who have good
verbal skills, or who are highly intelligent, or who have some less
obvious social impairment, are often said to have Asperger, Lord
Within individual centers, health professionals were consistent
on the criteria they used to diagnose children. The discrepancies
emerged when comparing one center's diagnostic criteria to
another's, she explained.
"It's really much more valid to talk about autism spectrum disorder," Lord said, with the acknowledgment that the people who fall within it can have a very wide range of abilities.
"Using one broad category and then characterizing the specific strengths and challenges of each child may be clinically more useful," added Dawson. "That said, people who have come to identify with a specific diagnosis, such as Asperger syndrome, may want to continue to use that diagnostic label. We need to be sensitive to the fact that some people with autism spectrum disorder may not embrace these diagnostic changes."
The U.S. Centers for Disease Control and Prevention has more
autism spectrum disorders.
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