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Module: Early Identification of Autism Spectrum Disorders
IMPORTANCE OF EARLY IDENTIFICATION
Potential Challenges to Early Identification
Reluctance to Diagnose Very Young Children
There are formidable social pressures on early childhood clinicians against making formal diagnosis of non-medical conditions early in life. The diagnosis of intellectual disabilities is a good example in point. In our experience, it is rare to find an interdisciplinary evaluation clinic or assessment team that provides the diagnosis of intellectual disability to children younger than 5, regardless of the severity of the intellectual deficit or delay. Professionals may not use these terms due to their own discomfort in delivering bad news to parents. Similar challenges exist for the early diagnosis of ASD. Furthermore, a diagnosis is not always necessary for a child to receive services. For the Part C Early Intervention Program of the Individuals with Disabilities Education Act, a child under the age of three may receive services due to delayed development without the diagnosis of a specific condition such as ASD.
Potential Negative Impact of Early Identification
Another real, and significant, concern about diagnosis, particularly early diagnosis, has to do with possible negative effects of “labeling” on the child and family. Clinicians, and parents, express concern that early diagnosis may change the parent-child relationship, may reduce expectations for the child’s development in ways that will be detrimental to the child’s progress, may limit the child’s access to typical experiences and opportunities, and may shift balance in the family structure (e.g., increasingly more attention of parents directed to the child with ASD and away from the other children in the family). Clinicians are also concerned about the possible effect of incorrect diagnosis early in life. Without empirical evidence of the “diagnosability” of autism in infants and toddlers, of the accuracy and reliability of very early diagnosis, it may seem more ethical for clinicians to wait until they are as certain as they can be about the diagnosis of autism. Otherwise, there is risk of making the diagnosis incorrectly and inadvertently creating harm, given all the pain and potential negative impact that the diagnosis carries for families. Given these substantive issues, arguments for early diagnosis require serious consideration and empirical demonstration that the benefits outweigh the costs.