Warning given on 'over-specialised' autism diagnosis

15th April 2011 at 01:00
Identifying complex conditions at young ages can create `real problems,' says expert

Teachers may be hampered in their work with pupils with learning difficulties because of premature and "over-specialised" diagnoses of conditions such as autism, according to a leading international specialist.

Autism, Tourettes and attention deficit hyperactivity disorder (ADHD) can "overlap to a great degree under the age of five" and a narrow approach to their diagnosis can create "real problems", Christopher Gillberg, professor of child and adolescent psychiatry at Gothenburg University and visiting professor at Glasgow and Strathclyde universities, has warned.

Early diagnosis of autism or ADHD can be reassuring for parents seeking an answer to their child's behavioural or developmental problems, Professor Gillberg said. But these conditions were "not clearly separable" and diagnosis of one condition could mean the impact of overlap with another was "missed".

Professor Gillberg told a Mindroom conference on learning difficulties, held in Glasgow, that services "should not be too focused on one disorder".

Julie MacRae, a teacher at the autism unit at Hillpark Secondary in Glasgow who attended the conference, said she had seen evidence of significant crossover between conditions, and cited examples where the behaviour of her pupils "contrasted with their diagnosis".

In her experience, many pupils had been diagnosed at the pre-school or early primary stage with autism or Asperger's syndrome, but had not been reassessed throughout the rest of their time at school to establish whether they had any other conditions. This was "entirely common", she said.

Early, inaccurate diagnosis could mean pupils' needs "may not be met as effectively as they could", while the "label" of having a specific learning disability from a young age could be detrimental to their social and emotional progress, she said.

"We're not clinicians and we can't change diagnoses but we do have a much better understanding of pupils because we work with them so closely and listen to them," she said.

Sophie Dow, director of Mindroom, a charity that campaigns for better support for children and adults with learning difficulties, suggested a marked increase in diagnoses of autism in children could mean other conditions were being overlooked.

It was important that a range of interventions were available so that parents of children with learning difficulties could find something that "always matches their specific situation", she said.

CPD Scotland adviser Margaret Orr, who was previously responsible for SEN at Glasgow City Council, agreed that having an early diagnosis was "not always the right thing to do" because children "are developing all the time".

But it "can be a Catch-22 situation", she said. "Sometimes it's essential that you have an enhanced clinical diagnosis - it can be a pragmatic response. At the same time there can be a danger that people then see the label but not the child."

She said there had been a marked improvement in professionals' response to children with learning difficulties over the past 10 years, and there was increasingly a culture where professionals could "respond to the child's needs in an overall way".

"For parents it's about having confidence in the range of professionals that are interacting with their child," she added.

Alison Garbett, head of services at Edinburgh's Visiting Teaching and Support Services (VTSS), which works with children and young people with disabilities from birth and throughout their school years, said the organisation collaborated with colleagues in health services and that their process of diagnosis was "robust".

Children had to demonstrate a "triad of impairment" for a diagnosis of autism spectrum disorder but "other aspects were looked at concurrently," she added.


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