Why Does My Autistic Child Have Multiple Diagnoses?

Question: Why Does My Autistic Child Have Multiple Diagnoses?

It's not unusual for a child to receive an autism spectrum diagnoses along with such diagnoses as ADHD, obsessive compulsive disorder, non-verbal learning disorder, and so forth. Why does this happen? What are the rules around diagnosis?

Answer: Why would a child with autism have multiple diagnoses to describe the same set of symptoms? Of course, if your child has autism and also has diabetes, it's easy to understand multiple diagnoses. But since autism spectrum disorders are "pervasive developmental disorders" with features such as repetitive actions, social communication delays, inattention and more, it would seem reasonable that one diagnosis would be sufficient to describe all of these issues.

Unfortunately, there are no clear cut rules for diagnosing developmental delays and differences. In fact, according to Dr. Ann Asher of the National Institutes of Health, "We recognize there are many causes of Autism Spectrum Disorders (ASD's); with that realization there’s more willingness to dually diagnose. People will give an ASD diagnose if a child meets the criteria, along with another diagnosis. There’s no hard and fast rule about this. The answer is based on tradition."

What does this mean to you? Your child, depending on which doctor or doctors he has seen, may provide a whole alphabet soup of diagnoses to describe symptoms. This can lead to some real problems for kids, parents, and teachers.

For example:

• A doctor may provide an Asperger syndrome diagnosis to describe social and communication differences, but also diagnose ADHD to describe attentional issues. The fact that the attentional issues result from sensory problems or communications issues related to the Asperger syndrome may be ignored, and the child may be put on ritalin or a similar drug to no effect.

• A doctor may provide an autism diagnosis along with a diagnosis of social anxiety, ignoring the fact that the social anxiety may well be an outcome of the autism. As a result, the child may be placed on an SSRI medication (most often used to treat depression, but also used for anxiety issues), while the environment which is causing the anxiety may not be addressed.

• A doctor may describe a child with autism as oppositional and defiant (ODD), without looking closely into what is causing the child's oppositional behavior. As a result, the child may be placed into a class with emotionally disturbed children when better supports and tools for anxiety management would have made inclusion possible.

It's important for parents to be aware that multiple diagnoses may or may not be appropriate, and to question diagnosticians when multiple developmental diagnoses are applied to their child. While your child with autism may, indeed, have multiple disorders, it may also be the case that an autism spectrum diagnosis covers all the facts -- and that appropriate autism treatments cover all your child's needs.

_Sources:

Interview with Dr. Ann Wagner, Ph.D. Chief, Neurobehavioral Mechanisms, Division of Services and Interventions Research, National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services. September, 2010.