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Autism, The Chameleon of Child Psychiatry


If it looks like a duck, quacks like a duck, swims like a duck and is with a family of ducks, it is most likely to be a duck. It could be an ugly duckling that morphs into a swan but most likely it is a duck. Yet you need to know what a duck looks like.


In my 30 plus years of clinical practice as a child psychiatrist I have seen the rate of autism increase and become considered a spectrum of different symptoms and severity. The strengths and positive qualities of this neurodivergent population is also being appreciated and valued. Yet children who are neurodivergent still struggle with the challenges placed upon them by a neurotypical world and do require support to negotiate their development more smoothly.


As a trainee I was chided by my fellow workers as seeing autism in everyone. Yet I observed that many children diagnosed with ADHD, Oppositional Defiant Disorder, Depression, Anxiety, OCD and even Psychosis were likely to be on the Spectrum, way before that concept was included in the DSM. These patients were quirky and if you took the time to ask about their developmental history it was clear that they thought, felt, and perceived the world differently. Their inattention may have been due to sensory overload, their oppositional behaviour due to not understanding direction, meltdowns caused by sensory overload or changes in routine, low mood by constant failure or not fitting in, anxiety by the unpredictable environment around them and some were even diagnosed with psychosis as they could not explain their internal experiences and they were misunderstood as a psychotic experience.


Comorbidity is common in autism and needs to be assessed and managed, but my concern is that autism is often missed, mistaken for the comorbidity and the early interventions that are so important are delayed or never started. Autism is sometimes quickly discounted because a child could maintain eye contact, or hold a conversation, but without further questioning many other symptoms of autism remain uncovered. Managing a young person with underlying autism by only by treating the comorbidities is not effective as a child with autism needs a very different management plan.


So, if a child presents as quirky or some social difficulties, odd preoccupations, rigidity in routine, eye contact difficulties or sensory issues such as putting their hands over their ears to loud noise, always ask “Could this be an Autistic Spectrum Disorder”? I am surprised that many children with autism come to my office and have been seen by other health professionals and the diagnosis missed, especially in mild cases and in girls. If uncertain I obtain further information and assessments to help clarify the diagnosis, but I would never support a wait and see approach. Early intervention is critical. I advise parents if they think that a professional opinion is not in keeping with what they see or suspect, then obtain a second opinion.


Not diagnosing early leads to missed opportunity for early intervention which has clearly been shown to be vital. So early diagnosis is crucial to help these children thrive.


So, if a child looks like they have autism, sounds like they have autism, move like they have autism and have a family with some quirky family members ask yourself “Could this be Autism?”. It may well be and you have done the family a great service.

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