Challenges Surrounding the Diagnosis of Autism in Children

Abstract

This comprehensive thematic review aims to highlight and familiarize readers with the challenges and pitfalls encountered in differential diagnosis of autism spectrum disorders (ASD) in children to facilitate the process of accurate identification by stakeholders. Accordingly, articles that best answer our questions and highlight our concerns were chosen from well-established publishers with prime peer reviewed journals. Included are studies showing alternate views of the issues so as to point readers to other possibilities. ASD, a complex dynamic biological-neurodevelopmental disorder, is underscored by its heterogeneous symptomology, severity, and phenotypes -all characterized by social communication deficits and presence of restricted interests and repetitive behaviours (RRBs), the core symptoms in ASD. Language and intellectual capacities do not form ASD core symptoms although vary considerably. Accurate identification is challenging as ASD is often enmeshed with other neurodevelopmental disorders, and medical comorbidities, a situation now recognized as the rule rather than the exception in child psychiatry and developmental medicine. ASD is a disorder with varying performance and severity of symptoms over time, including unexpected loss of early skills, and lost diagnosis in some children following treatment. The review reiterates the urgency in accurate diagnosis in face of the rapid rise in ASD prevalence globally, and risk-increase in delayed or denied treatment with undesirable life-long consequences for most of the affected children. In addition, a call for change is advised to circumvent the ethical dilemma posed by the present "deficit model" in ASD diagnosis. Here, ASD prevalence is presented first, followed by emphasis on importance of accurate early diagnosis, and challenges in its accomplishment due to flaws in diagnostic instruments and other contributing factors. Next follow the required criteria for accurate identification, and its difficulties attributed to comorbid conditions, gender differences, and socio-economic and cultural influences. The conclusion includes future directions and a take away message.

Effects of Washed Fecal Bacteria Transplantation in Sleep Quality, Stool Features and Autism Symptomatology: A Chinese Preliminary Observational Study

“…There are many limitations in the diagnosis and treatment of early autism worldwide. 39 In recent years, the relationship between gut microbiota and ASD has drawn great public attention, and it refers that this relationship between the emotional state and the abundance of intestinal microbes was named the microbiota-intestine-brain axis. The previous study has indicated that the ASD symptoms, gastrointestinal symptoms and GM composition have been improved after the intervention of prebiotics, probiotics and WMT.…”

Pathogenic Infections during Pregnancy and the Consequences for Fetal Brain Development

“…However, despite the fact that this male preponderance is not specific to ASD, it has been viewed as a crucial indication to identifying the underlying cause. The male preponderance does not appear to be directly linked to genetic factors, as the sex-skewed expression of neurodevelopmental risk genes has not been identified [79,80]. It is also possible that the diagnosis may be affected by the fact that males with ASD tend to demonstrate more expressive behavior (for example, repetitive and aggressive behavior), whilst females tend to display more affectionate behavior (for example, emotional symptoms).…”

Language and Speech Characteristics in Autism

“…The individuals with ASD often present limited interests, follow stereotyped behaviors and adhere to repetitive rituals. 14 …”

“…Although the hypothesis of influence of social development is a crucial cause for the language and speech difficulties in ASD children, there are other conditions which may affect speech and language development. Comorbidity conditions of ASD children with other developmental disorders such as Developmental Language Disorder (DLD), Apraxia of Speech (AS) or low Intelligent Quotient (IQ) level 14 also influence language and speech abilities in ASD because development is generally seen on a continuum.…”