Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, October 12, 2014

"As Prevalent
As The Common Cold"

"These disorders are typically considered lifelong disabling conditions. So, the fact that such a large percentage of children no longer fit the criteria for the diagnosis in some later part in childhood begs the question: Did these diagnoses apply in the first place?"
"A boy who has a traditionally masculine way of communicating and playing (may appear) autistic-like. Boys are about a year behind girls in basic self-regulation (the ability to sit without a wiggly body, pay attention and follow instructions)."
"We've loosened the criteria so much and become so casual in how we discuss these diagnoses. [As a result], a large percentage of children who are just going through developmental struggles and transitory life problems are being caught in a diagnostic dragnet."
"Many children, when they're being assessed by a professional, especially in the younger years, shut down and behave strangely. Parents need to bring that to the attention of the professional and say, 'Let me give you a fuller picture of my child's behaviour'."
Dr. Enrico Gnaulati, psychologist, Pasadena California

"This isn't a case of over-diagnosis. Clinicians carefully assess the many facets of development prior to making a diagnosis of autism spectrum disorder. One symptom or difference in behaviour does not constitute an autism spectrum disorder diagnosis."
Dr. Lise Bisnaire, director, autism program, Children's Hospital of Eastern Ontario

"When you look at every item on the list [of diagnostic criteria; trouble concentrating, easily distracted hyperactivity, forgetfulness, fidgeting] and put check marks, that's a misuse of the criteria, and that will lead to an over-diagnosis."
ADHD is not on the rise. [The numbers should be] relatively stable."
Dr. Philippe Robaey, head, ADHD and Disruptive Behaviour Clinic, Children's Hospital of Eastern Ontario

Dr. Robaey's estimate is that roughly half of the approximately ten percent of Canadian children diagnosed with ADHD, should rightfully be given that diagnosis. And what of the other half who are diagnosed and though they appear symptomatic, they aren't really suffering from ADHD? Which is precisely Dr. Gnaulati's point.

A report from the National Epidemiologic Database for the Study of Autism released in 2012 concluded that autism rates in various parts of Canada increased from 39 to 204 percent with cases of attention deficit hyperactivity disorder (ADHD) also having seen an increase. The American Centre for Disease Control and Prevention states that approximately 11 percent of children between the ages of four and 17 were diagnosed with ADHD in 2011, representing an increase from 7.8 percent in 2003.

Dr. Gnaulati has published a book that explores and he feels, validates his thesis of over-prescription, titled Back to Normal: Why Ordinary Childhood Behaviour Is Mistaken for ADHD, Bipolar Disorder and Autism Spectrum Disorder, and has, in the process become "as prevalent as the common cold". The seeming epidemic, he argues represents a societal problem, not a mental health crisis, as many hand-wringers believe.

The rising rates of both childhood maladies indicate gross misdiagnoses, as far as he is concerned. And he makes reference to a National Institutes of Health study indicating 75 percent of people diagnosed with ADHD as children no longer meet the criteria in their mid-20s, as well as a study from the University of North Carolina-Chapel Hill showing that 30 percent of children with an autism diagnosis at age two no longer at age four fit the criteria for that diagnosis. An odd turn of events for a mental health condition considered to be a lifelong problem.

Dr. Gnaulati feels the culprit of increasing academic pressure on younger children risks placing children, in particular boys, at risk of false mental health diagnoses. Greater education, he holds in the case of autism, may be the cause of rising rates. He points out that children in their toddler years, and particularly boys, can exhibit behaviours and moods that may mimic those of an autistic child.

He cites the obvious, in a quiet child preferring to remove himself from social turmoil and interaction; the preference to play in isolation, repetitive object manipulation, unwillingness to make eye contact, and discoursing at length with the enthusiasm of their favourite topic, all behaviours commonly linked with autism. But, at the very same time, behaviours typical of some young boys.

Dr. Bisnaire disagrees completely, insisting that the increase in autism diagnoses among daycare and school-age children is attributable to broader definitions of the disease, linked with better identification, citing research examining a number of risk factors inclusive of genetic and environmental factors. Her argument is to rebut Dr. Gnaulati's that health professional are not capable of differentiating real autistic behaviour from normal toddler mannerisms.

"When you look at every item on the list, none of them is abnormal alone", agrees Dr. Robaey, finding common cause with Dr. Gnaulati. Family physicians commonly use online ADHD checklists, as do parents and teachers, and as such can also help to account for the increase in diagnoses. But reliance on such criteria in isolation doesn't take into account alternative explanations of a child's behaviour, often enough linked to problems at home or school.

In the rush to label and medicate a child who appears difficult to handle, Dr. Gnaulati feels that up to 30% of children are being identified as suffering from ADHD. Parents, he feels, have a special need to ensure a more accurate diagnosis by explaining what they perceive as ambiguities in their child's behaviour; remote and distant at school, yet anything but at home when he is relaxed and happy. An accurate diagnosis must be based on a well-rounded view of a child's performance.

And, of course, there is the oversized pink elephant in the room; everyone's anxiety to control certain behaviours seen as disruptive, troubling and nonconformist attention-grabbing; that the solution to a child's reactions to the world around him can be handled with medicating him.

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