Diagnosis: Autism

Surviving the Worst News You'll Ever Get
Question: I saw my pediatrician yesterday, and she asked me if my two-year-old child was talking. I said he doesn't say a word yet. Then she asked if he played with other children. I said he doesn't take much interest in other children, and sometimes he just seems like he's in his own little world. Then she pulled out a brochure on autism. Just like that. I was shocked. Is it possible that a child this young could have autism? And, if so, what do I do now?

Question: My child is four. When she was three, she could recite nursery rhymes and count to ten. She also knew most of the alphabet. We thought she was a genius. But in the last year she hasn't seemed interested in talking with us much. At the park she pushes the other children away and just seems to want to sift sand through her fingers. My sister asked me if I've considered the possibility that she has autism, but she likes to cuddle with me and doesn't seem to mind being touched. That doesn't sound like autism, does it?

Autism is one of the most alarming diagnoses a parent can hear. Every parent has hopes and dreams for her child, and often these can be shattered when the child gets diagnosed with autism. Most other diagnoses dictate a clear course of action and lead to an undisputed likely outcome, but every child with autism is different and will progress differently. There is no known cause and no known cure. Not only is it a serious disability – it's also a bewildering one.

I love my job. In fact, I am one of the few people in the world who can honestly say that each day I get up, I feel fortunate to be able to do something I love. But delivering the news that a child has autism is the one part of my job that I hate. Fortunately, most people who bring their children to see us already have a diagnosis or at least a suspicion that their child has autism – after all, they are coming to an "autism center." But when I do have to be the one to tell a family that their child has autism, it's painful and difficult. The one consolation I can give the parents is that with good intervention their child is likely to improve, and that although I cannot read the future, many children do improve enormously.

What Is "Autism" Anyway?
To understand what autism is today, a little history is helpful. Relatively speaking, the field of autism is young. In 1943 the term autism was first used by Leo Kanner, who wrote a paper entitled "Autistic Disturbances of Affective Contact." Autistic literally means "alone," and that's what Kanner observed – a tendency in these children to want to be alone. In this paper, published in the Nervous Child (a journal that no longer exists), Dr. Kanner described eleven children between two and eight years old who had similar symptoms, which included difficulties communicating with others, difficulties interacting with others, and unusual interests. Prior to this article, children with these symptoms were usually labeled "schizophrenic."