‘Co-Occurring’ Disorders May Explain Change in Autism Diagnosis

MONDAY, Jan. 23 (HealthDay News) — Many children with autism
also have other developmental or psychiatric conditions, including
learning disabilities, speech delays, attention or seizure disorders and
anxiety.

According to new research, some of those co-occurring conditions may
explain why autism diagnoses often change as children get older.

In a survey by researchers at Johns Hopkins Bloomberg School of Public
Health in Baltimore, more than one-third of parents with children between
6 and 17 years old reported that their child’s diagnosis of autism had
changed over time.

“We don’t know what changed the diagnosis. However, we want to deliver
the message that it’s important to look at the other coexisting
conditions, evaluate them before you make a diagnosis, and also recognize
these conditions vary by development age,” said study author Li-Ching Lee,
an associate scientist in the epidemiology and mental health departments
at the School of Public Health.

Autism is a neurodevelopment disorder characterized by problems with
social interaction, communication and restricted interests and
behaviors.

In the study, researchers used 2007-2008 survey data from the parents
of nearly 1,400 children aged 3 to 17 who had received a diagnosis of an
autism spectrum disorder (ASD), including autism, Asperger disorder — a
mild form of autism, and pervasive developmental disorder-not otherwise
specified.

Parents were asked if their child currently had a diagnosis of autism
or an ASD, or had had one in the past.

Nearly 26 percent of parents of children aged 3 to 5 reported a change
in diagnosis, the researchers said. Nearly 34 percent of parents of
children aged 6 to 11 and 35 percent of the parents of 12- to 17-year-olds
reported their child was diagnosed with autism at some point but no longer
was considered to have autism, the researchers found.

Overall, children with two or more co-occurring developmental or
psychiatric conditions were five times more likely than kids with fewer
coexisting conditions to continue to have an autism diagnosis, the
researchers said.

Kids who had a moderate-to-severe learning disability were 11 times
more likely to continue to have an autism diagnosis over time, while kids
with a developmental delay were nine times more likely to retain an autism
diagnosis, the study authors said.

Researchers didn’t look at why certain conditions are associated with a
change in autism diagnosis. But some of the symptoms of various
development and psychiatric conditions can overlap, so it’s possible that
having certain ones can lead to a misdiagnosis until the child gets older
and their issues become more clear, according to the study.

For example, kids diagnosed with a hearing problem showed a tendency to
“lose” their autism diagnosis over time. Researchers speculated that
behaviors that initially resembled autism symptoms — not responding or
not engaging — were later discovered to stem from impaired hearing.

The study is published in the February issue of Pediatrics.

Dr. Joseph Horrigan, assistant vice president and head of medical
research for the advocacy group Autism Speaks, cautioned not to make too
much of the findings. The children weren’t actually followed over time,
nor were they actually examined, a methodology that would be the “gold
standard” of research.

Because the results were based on a telephone survey, Horrigan said,
“I’d be a little cautious about over-interpreting whether this means
there’s likely to be change in an autism diagnosis or a loss of an autism
diagnosis for a given individual.”

Nor did researchers look at kids whose diagnosis went the other way —
that is, they were initially not diagnosed with autism but were later
diagnosed with it.

However, the findings highlight how often kids with ASD experience
other conditions, some of which may be treatable with medications or with
educational interventions. These include anxiety, attention-deficit
hyperactivity disorder (ADHD), depression, epilepsy and learning
disabilities.

“Up until the recent past, there’s been a tendency to spend most of the
time and energy on the autism and the autism diagnosis, and thinking about
a treatment package that’s keyed directly to the autism,” Horrigan said.
“What’s important here is they are highlighting some of the most common
co-occurring disorders, a number of which are readily amenable to
treatments.”

An estimated one in 110 U.S. children — many more boys than girls —
has autism, according to the U.S. Centers for Disease Control and
Prevention.

More information

The U.S. National Institute of Mental Health has more on
autism.

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