Who Should Diagnose Autism Spectrum Disorders?

Not Every Doctor Can Do the Job Correctly

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It seems that everyone, including the lady at the grocery store, can spot autism when they see it. But of course it's not that simple. Autism is not just a collection of personality traits and personal interests, and not everyone who prefers solitude and comic books is autistic. In fact, autism is a developmental disability -- and diagnosis requires testing, evaluation, and an in-depth understanding of the disorder.

Why Your Own Pediatrician May Not Be Able to Help in Diagnosing Autism

In theory, your own pediatrician should be able to pinpoint red flag behaviors or challenges that suggest autism. But your own pediatrician only sees your child once a year (if you're lucky) -- or when your child is sick. And even now, with so much awareness of autism spectrum disorders, most pediatricians have little knowledge of how to screen for developmental delays. What's more, pediatricians know that young children develop at very different speeds for a variety of reasons. Most children really do catch up to their typically developing peers. So many pediatricians tend to take a conservation "wait and see" approach.

If you do take your child to your own pediatrician, and that doctor reassures you that there are no issues of concern, you may decide to stop right there. And your pediatrician may be 100% correct.

But if you continue to have concerns, it can't possibly hurt to take the next step by asking your pediatrician to refer you to an autism specialist.

The best that could happen is that the specialist finds no issues. The worst that could happen is that the specialist does diagnose autism, which means you can get a head start on helpful interventions that can make a positive difference for your child. 

What Is an "Autism Specialist?"

Before 1994, autism was a rare disorder.

Today, it's relatively common, as a result of changes in awareness and diagnostic criteria (among other factors). But there are still relatively few medical professionals who are specifically trained to diagnose and/or treat autism. As a result, the people who are best qualified to diagnose children with autism are those professionals who have had the most experience in doing so -- and those professionals may have a wide range of titles. These may include:

In addition to these medical professionals, there are many therapists who can take part in a multidisciplinary evaluation of your child. While these people are not medically trained, they may know as much or more about autism as a highly trained doctor -- simply because they spend so much time around autistic people. These individuals may include:

Because there is no medical test for autism, diagnosis is based on a combination of parent interviews, non-medical tests, observation, and professional judgement.

That's why experience, in addition to training, can be critical in providing a meaningful diagnosis.

Who Should Diagnose My Child?

With so many possible options, who is the right person to diagnose your child? The answer depends, to a large degree, upon who is available. Depending upon where you live, you may find that there is a long wait to see a developmental pediatrician -- while you can get in to see an experienced child psychologist almost right away.

Another issue to consider is money. You may discover that, while a neurologist is covered by insurance, a psychologist is not. In some states, early intervention programs provide free multidisciplinary evaluations; in other states, such evaluations may be hard to access.

A word of advice from highly experienced psychologist Dr. Robert Naseef: Even if your initial diagnosis comes from a psychologist, it may be worth your while to also consult an M.D. The reason is more political than medical: without an M.D. behind your child's diagnosis, says Naseef, your local school district may not provide an appropriate array of services.

Finding the Right Person to Diagnose Autism

The right person or group to diagnose your child will be trained, experienced, affordable and available in your area. To find that person (or group):

  • Start with your own pediatrician. He or she may have a terrific list of names, and may even be able to help you get an appointment quickly.
  • Connect with other parents. Local support groups and listserves are wonderful resources for information about professionals who are both competent and supportive.
  • Check with your school district and/or regional agencies. You may find there are low-cost or free options available to you.
  • Surf the web. If you live outside a major city, you may find terrific resources that your suburban sources know nothing about.
  • Do your homework. Check on the recommended specialists to be sure that they really have the credentials and experience you want.

References:

  • Interview with Dr. Robert Naseef, January 2007
  • Early Diagnosis of Autism Spectrum Disorders Jennifer Pinto-Martin, PhD and Susan E. Levy, M.D. Current Treatment Options in Neurology 2004, 6:391-400
  • American Academy of Pediatrics: The pediatrician's role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics 2001 May;107(5):1221-6.
  • National Institute pf Mental Health, Autism Spectrum Disorders (Pervasive Developmental Disorders) A detailed booklet that describes symptoms, causes, and treatments, with information on getting help and coping. 2004

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