When It Is Not Autism: Examining Alternative Diagnoses

By Timothy Gunn, Psy.D.

When It Is Not AutismAs awareness of Autism Spectrum Disorder has increased, there has also been a rise in the number of cases of the disorder. In 2000, it was estimated that approximately one in 150 children met criteria for autism, but that number has increased to one in 68. Some experts now question whether this means more children actually have autism, or whether the increase might be due to expansion of the definition of autism or due to increased awareness of the disorder.

I believe that at least some of the increase is due to inaccurate diagnoses. Some children simply develop more slowly than others, mastering speech later than most children but eventually becoming fluent speakers and never developing any of the other symptoms of autism. There are also a number of conditions with symptoms similar to ASD, but that are separate disorders.

Language Disorder: Many people are aware that a delay in spoken language could indicate ASD. However, it is important to note that autism is essentially a social disorder and not a language disorder. It is possible for a child to have a language disorder without the social impairments that characterize a child with autism.

Anxiety/Depressive Disorders: Anxiety and depression can cause children to behave in atypical and socially awkward ways. Children with a chronic anxiety disorder, including the formal Social Anxiety Disorder, might struggle tremendously with social skills. Children with depression might avoid eye contact, withdraw from social situations, show reduced social interests and display limited verbal interaction. It is critical to properly diagnose the correct condition, because treatment will be very different for a child with depression or anxiety than for one with autism.

Poor Adaptability and Explosive Anger: I have noticed an increasing number of children referred for autism evaluations when their primary symptoms are disliking change, struggling to manage transitions from one activity to another, or becoming agitated or aggressive when they are asked to adapt to unavoidable changes in their environment. These symptoms are also seen in some children with autism, but wouldn’t be sufficient for a diagnosis of Autism Spectrum Disorder on their own. The ability to adapt to change and manage frustration are developmental skills, which simply develop slower in some children than in others.

This isn’t a complete list of conditions that might look like Autism Spectrum Disorder, but should give people who have concerns about autism in a friend or family member food for thought and help them better advocate for their children as they seek out diagnoses from qualified professionals.

Autism Spectrum Disorders are complex disorders that cannot be diagnosed hastily or based strictly on limited interaction with the child. I have found that when children are diagnosed inappropriately, the diagnosis has often come after only a brief office visit and discussion of some symptoms. If parents have received a diagnosis that they question, they should seek a second opinion.

When taking a child for an evaluation, begin by discussing the specific symptoms you (the parent) are concerned about. For example, “I’m concerned that my child doesn’t seem to be talking as much as other children his age.” If the treating professional brings up the possibility of a specific diagnosis (e.g. “Have you ever thought that your child may have autism?”), suggest alternative diagnoses as well. For example, the parent could say, “Yes, but I’ve also read that kids with Language Disorders behave the same way,” or “Maybe he is just slow to speak but still within the normal range.” This presses the treating professional to consider other possibilities, rather than just looking for information that supports a single diagnosis.

In October 2011, California passed a law mandating that insurance providers cover treatment for Autism Spectrum Disorders. Thus, there is typically insurance coverage for both evaluation and treatment of autism and competing disorders. When seeking an evaluation, especially if using private insurance, I recommend either obtaining an evaluation from a clinic that does not also provide the treatment, or informing the clinic in advance that you intend to have the evaluation and treatment (if necessary) provided by separate clinics. If a clinic provides both the assessment and the treatment services it can introduce a bit of a bias toward diagnosis, since they would then be able to provide the treatment as well.

Dr. GunnThis isn’t meant to be a hard-and-fast rule. I’m sure some families will feel comfortable with a particular clinic and want to stay with them, but my recommendation would always be to let them know up-front that you would be exploring treatment elsewhere and just need an independent diagnosis.

Timothy Gunn, Psy.D., is a licensed clinical psychologist with several offices in the L.A. area. He provides assessment services for children and adults. Learn more at www.gunnpsych.com.

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