Friday, May 20, 2005

Why Behavioral Checklists for ADHD and Autism Stink

More reasons to believe that behavioral checklists are a lousy way to diagnose ADHD and Autism- two recent studies have now found that perinatal stress (or mild birth injury by implication) greatly increases the likelihood a child will be diagnosed with ADHD or Autism. Hmmm - is this a coincidence? Probably not. Both ADHD and Autism use cafeteria-style checklists to diagnose children, and the overwhelming number of children are never examined by a neurologist who might detect specific patterns of neurologic disability that suggest an injury from birth.

Does it matter? Absolutely. As it turns out there are many different ways in the brain that a little patchey injury can cause unwanted behaviors like hyperactivity, inattentiveness, poor eye contact, or poor social interactions, but many differences as well. And its these differences that require different interventions and recommendations as well as resulting in very different outcomes. The problem today is there is so much that is getting lumped under the ADHD and Autism diagnoses (or Aspergers or PDD-NOS) that inappropriate placement and educational decisions, and even parenting decisions are made.

Both research reports are available as full text below.

The ADHD study looked at risk factors within families - so comparing children to unaffected family siblings - and this was a good idea. ADHD was highly associated with neonatal complications (p < 0.006) and in addition it also correlated with significantly higher mean scores on the total CBCL (72.0 vs. 66.4). Neonatal problems were also associated with higher externalizing scores - including impulsivity, and poor performance on the CPT. Specific neonatal risks were seen with NICU hospitalization, oxygen therapy, general anesthesia, and surgery.

The Autism Report saw lots of perinatal risk factors again - being premature resulted in a 2.5x increased risk of autism, low Apgars (birth stress, poor breathing) was almost 2x an increased risk of autism, breech birth 1.6x increased risk, and parental psychosis 3.4x increased risk for autism.

Do these look like a single thing to you?

Risk Factors for ADHD
Risk Factors for Autism Res Paper
WebMD article autism autism article

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