Several years ago, Gary L. Freed, MD, chief of the Division of General Pediatrics at the University of Michigan, initiated a survey of physicians listed as pediatricians on state licensure files in eight states across the United States: Ohio, Wisconsin, Texas, Mississippi, Massachusetts, Maryland, Oregon, and Arizona. According to the survey, 39 percent of state-identified pediatricians hadn't completed a residency in pediatrics. And even for those who had, their training in pediatric mental health was minimal.
Currently, the American Academy of Pediatrics estimates that less than a quarter of pediatricians around the country have specialized training in child mental health beyond what they receive in a general pediatric residency. The latest data examining pediatricians who have launched themselves into practice reveals that 62 percent of them feel that mental health issues were not adequately covered in medical school. These figures hardly inspire widespread confidence as regards relying on pediatricians to accurately diagnose ASD.
This brings me to my own cherished profession: child psychology. What does survey data tell us about the current training of child psychologists that speaks directly to their ability to separate out abnormalcy from normalcy?
Poring over the numbers of a 2010 study out of the University of Hartford in Connecticut, I discovered that 45 percent of graduate students in child psychology had either no exposure to, or had just an introductory-level exposure to, coursework in child/adolescent lifespan development. It is in these classes that emerging child psychologists learn about what is developmentally normal to expect in children.
It would appear that the education and training of a sizable percentage of pediatricians and child psychologists leaves them ill-equipped to tease apart the fine distinction between mild ASD and behaviors that fall within the broad swath of normal childhood development.
When the uptick in ASD numbers was made public by the Centers for Disease Control and Prevention the week before last, Dr. Marshalyn Yeargin-Allsopp, chief of their Developmental Disabilities Branch, said in a press release, "The most important thing for parents to do is to act early when there is a concern about a child's development. If you have a concern about how your child plays, learns, speaks, acts, or moves, take action. Don't wait."
On the one hand, a clarion call of this nature is the push the parents of a child with an unmistakable case of moderate- to severe-ASD (like Isabel above) absolutely need. On the other hand, Dr. Yeagin-Alsopp's remark seems to stoke the very anxiety that haunts the average parent of a slow-to-mature, but otherwise normal kid, edging that parent to transport the kid to a doctor, where there's a good chance that doctor will lack a solid knowledge-template as to what constitutes normal.
Early screening and treatment for ASD must remain a top public health priority, but the numbers make it clear that professionals would benefit from familiarizing and re-familiarizing themselves with the broad range of what is considered normal early childhood development, and with how young boys and girls differ in behaviors that resemble autistic phenomena. Otherwise the ASD numbers will rise, yet again, with a pool of slow-to-mature children being falsely diagnosed.