Every paediatrician can spot a child with autism?

‘Course everyone can spot a child with autism. It’s there in the MRCPCH textbooks right? Something about a lack of speech and gaze avoidance and repetitive behaviour. That must be pretty amenable to a spot diagnosis.

This is me being a little provocative because hopefully very few, if any paediatricians think like this. Hopefully we all know that the condition exists on a spectrum (autistic spectrum disorders right?) and that often a diagnosis can be challenging.

One of the challenges for example can be assessing a child who may have high functioning autism where the stereotypical features may not be present in the way you expect them to be. In this situation what is important is being able to spend time with the child just engaging them in conversation. It is time well spent and the time getting a child to relax and open up may transform a conversation which seemed pretty ordinary into a one-way monologue on the history of Ferrari and the intricacies of the engineering in the latest Enzo (true story). It is also why the diagnosis should never be made in isolation, and why a battery of tools and sources of information are to be used in the diagnostic process.

That’s why I thought this new study was interesting. It provided two “experts” with video tapes of children with (n=14)and without autism (n=14) and those with speech disorders (n=14) and asked them to decide on the presence of normal and abnormal behaviourisms and whether a referral for further investigation should take place. Although you ought to read the paper in full, in summary, incorrect referral decisions were made 39%(autism) 25% (speech disorder) and 11% of the time (normal)for each of the three groups. This translated into a sensitivity of 0.61 and specificity of 0.82, a positive predictive value of 0.63 and negative predictive value of 0.81.

Part of the issue according to the authors is that children with autism may show large amounts of normal behaviour which drowns out the abnormalities and this argues not only for the comprehensive assessments we conduct on these children but also (to my mind) for clinicians not being made to adopt a conveyer belt approach to their clinics. Take your time, it’s worth it.

– Munib Haroon

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