Friday, January 07, 2005

Autism Spectrum Disorders : Why Does It Take 5 to10 Minutes to Make A Diagnosis?

Child has streaming videos and interviews and it's a wonderful effort to provide more information about autism from the Dan Marino Foundation. But one neurologist interviewed in a segment admitted he needed only an hour clinic visit to get a full clinical history from the parents, examine the child, and then make his diagnosis. We know this is the norm rather than the exception. But we have to ask, why is it that physicians take so little time so little time to make "The Diagnosis"?

In fact, we have heard physicians counsel, "it takes only 5 to 10 minutes to make the diagnosis, but months to understand the disease..." , referring to the 5 to 10 minute Gilliam Autism Rating Scale to make the diagnosis, but what is really going on here? We want to trigger a little soul searching on this point. It takes time to establish a relationship with a child, to see him play, to see how he uses language, to see how he can be drawn out, to see how he interacts with you and others, and to figure out how his individual nervous system is wired. Brain-based processing cues are complex and difficult to sort out. Is he missing visual cues because of eye movement or perceptual problems? Could there be a peripheral or central (brain-based) auditory processing deficit? How are his needs being expressed? What is he missing?

We know it's very important to identify children who need help, but before we sign this child up for self-contained classes, intensive behavioral therapy, or a psychiatric medication trial, shouldn't we figure out more about what's going on? The rates for the diagnosis of autism are skyrocketing (as high as 1 in 250 children by some reports) and from academic centers and parent support groups we have heard calls for earlier ages of diagnosis. But before we hasten to provide the solutions, we must ask, have we accurately identified the problems?

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  1. Anonymous7:45 AM

    It seems many doctors feel their purpose is foremost "identifying the problem", which is to say choosing an illness or set of them from the DSM. They focus less on identifying the problems that a particular person has and figuring out how to overcome them. Unlike other common diseases and afflictions in most mental illness there is no pathogen to be identified and removed or no piece of the body to be repaired. If someone has pain in their leg, the most difficult part is often finding the source. If a broken bone is found, it can easily be mended and the procession from diagnosis to cure is relatively simple. However a simple diagnosis of schizophrenia is only the beginning of the long road of treatment, it's identifying a general set of problems that must later be narrowed down to the issues surrounding a specific patient, and those issues need to be addressed in that particular person's best interest. It seems to me that the first part is quick and what's referred to when they talk about diagnosing someone in a few minutes, but frequently overgeneralizes a person's illness and they are often never given the specific attention they deserve.

    When I was diagnosed with AS last year, I was sent to a psychiatrist by my psychologist (neither of who I thought were very good). This psychiatrist looked over the notes given to him by my psychologist, talked with me for a little bit, and 45 minutes later had diagnosed me with AS, ADD (well, affirmed a previous diagnosis) and mild OCD. He put me on one medication to start with (and raised the dose after a week) and was planning on giving me another after a month. I reacted poorly to the first medication and my health insurance was about to run out, so I never went back. Although I do feel his diagnosis was correct, I didn't feel as if he was really paying attention to me or was making an attempt to really address my issues in-depth. I had 8 typed pages of things I wanted to go through with him that I never got around to. I guess the psychologist may have gone more in depth with me later, but I still found the situation inadequate.

  2. You've identified real problems the ways these conditions are diagnosed. But if their role is 'diagnose and adios' - then who is going to provide real and specific guidance about questions that arise- mental blocks, learning glitches, brain-based perceptual challenges- and the like?

    Unfortunately it looks as if clinicians were caught by sharp rise in conditions like AS, ADD, OCD, or Bipolar. The inadequacies of the checklists and pharmacological match-ups is a genuine problem.

    Currently see an interest in 'neurologically-based learning' from many different disciplines within medicine and medical science (pediatrics, psychology, psychiatry, etc). This is a good thing, but what would be helpful is to have informed practitioners who can provide more feedback about individual differences in the way we are 'wired' to help us negotiate our world a little better.