Change your doctor?
Dear Dr. Lanny: I have been told my younger son, age 2, has autism spectrum disorder. I wonder if I should seek out a new pediatrician, someone who treats a lot of autistic kids, or stick with our current doctor, who has been seeing my little boy and my older boy, age 6 (and “neurotypical”), since they were babies. What do you think?
A: Before answering your question, I would like to talk about what autism is.
In days gone by autism usually referred to a child unable to have any meaningful relations with those around him, and who sat off in a corner flapping his hands, or constantly spinning the wheels on a toy truck. He had minimal or no language skills. And it was usually “he,” with boys outnumbering girls about 4 to 1.
Although there are children as severely affected as this, autism, now called autism spectrum disorder (ASD), includes a range of behaviors from very serious to hardly noticeable. The other common names associated with ASD are Asperger syndrome and pervasive developmental disorder, or PDD.
ASD represents a group of developmental disorders that appear in the first few years of life and affect the brain’s normal development of social and communication skills. Difficulty assessing the incidence of ASD, as well making the diagnosis in a single individual, is due to the lack of a definitive test. Many emotional or developmental problems are clinically diagnosed; they are recognized by a pattern of symptoms and behaviors, rather than blood work, MRI or other technological marvel.
Now to return to your original question. Should you change to a doctor specializing in autism?
My first response is that you don’t have an autistic child. You have a child who has autism. I believe there is a significant difference. The child with autism is still a child who will likely have the same problems as his unaffected sibling. Many children on the autism spectrum will be social, communicative and more typical than atypical. If you are happy with your present doctor and she doesn’t have hesitations about caring for your newly diagnosed 2-year-old, I would not change. Care for many autistic characteristics is largely through school and community-based organizations, rather than your doctor. Your doctor should be available for the usual illnesses of childhood, the possible co-morbidities (frequently associated problems) of autism, and to serve as your advocate and translator in dealing with the medical and educational communities.
In many cities and towns there will not be any doctors specializing in autism and developmental disabilities. In Syracuse, we are fortunate to have a special clinic to help with diagnosis, and to be a resource for your doctor: University Hospital’s Center for Neurodevelopmental Pediatrics (464-5540). One of the clinic’s physicians, Gregory Liptak, is a member of the American Academy of Pediatrics Council on Children with Disabilities Executive Committee. An evaluation by Dr. Liptak or his colleague, Louis Pellegrino, is certainly a reasonable strategy. Their evaluation and recommendations would then go to your pediatrician, who would consult the clinic as necessary.
Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at email@example.com.