Otolaryngologists play a key role in the care and diagnosis of children with speech delay and therefore should know the early signs of autism, Dr. Cullen said, describing a picture of three apparently happy and outgoing siblings. The boy in this picture was diagnosed with autism at age three, had early intensive treatment for three years and now he is doing very well. He is seven years old, is in second grade, needs very little help, rides a bicycle-and it is difficult to see the difference between him and other children his age, she said.
Explore This IssueOctober 2008
Dr. Cullen said that otolaryngologists can serve an important function in early diagnosis and treatment of autism because of the prominence of speech delay in the children with the disorder. Speech delay, suggestive of hearing problems, often results in these children being referred to and seen by otolaryngologists before other clinicians or parents have begun to think about autism.
When a young child has a noticible speech delay, we are among the first specialists to be consulted by pediatricians to rule out ear conditions and hearing loss. If we as otolaryngologists are aware of some of the early signs of autism, we can suggest to the pediatrician that the child be referred for further evaluation by a developmental pediatrician for diagnosis, Dr. Cullen said.
We are not asking the otolaryngologist to make a diagnosis of autism, she continued. Otolaryngologists should perform a routine ENT physical evaluation and also observe the child’s behavior during the routine examination-without taking additional time or asking questions. We ask our otolaryngology colleagues to watch for the ‘red flags’ of autism and report these findings to a pediatrician and, if appropriate, suggest a workup including referral for further evaluation to a developmental pediatrician or other specialist, she said.
When something just doesn’t seem right about a child, then otolaryngologists should act on their hunch, said Leslie Rubin, MD, President and Founder of the Institute for the Study of Disadvantage and Disability, a Visiting Scholar in the Department of Pediatrics at Morehouse University School of Medicine in Atlanta, and Director of the Autism Program at Children’s Healthcare of Atlanta’s Hughes Spalding Children’s Hospital.
All of us as clinicians need to be sensitized to be aware when something does not quite fit, he said. We may be missing something if we don’t pay attention to the subtle differences.
Dr. Rubin said that autism spectrum disorders are neurodevelopmental conditions that have origins early in life and are identified by delays or significant differences in a child’s development. They involve function across more than one domain-we are not talking about physical illness here. We are talking about the child’s development and about function. We are talking about speech, eye contact, socialization, physical coordination, sensory integration, and possibly behavioral challenges. In the context of the autism spectrum conditions, we are talking about a greater degree of complexity than just speech delay.