By Daniel B. Kessler
What specialists should a child with autism see? This is another controversial area, so again what follows are my opinions and my recommendations. You should always seek out the advice of your own physician.
Geneticists (genetic or inheritable disorders): Of the 10 percent of children who may have an identifiable genetic condition, half should be identified by a good physical examination by a trained geneticist and now-standard genetic testing. The other half may require more specialized molecular chromosome studies. There are always going to be improvements in our ability to diagnose, but for the majority of children with autism we will not find a cause.
Neurologists(brains and nervous system): Neurologists are sometimes called upon to diagnose autism. However, in state regulation only a licensed psychologist, psychiatrist or (with appropriate review by the Medical Director of DDD) a developmental pediatrician can diagnose autism. This probably needs to be rethought as it has little to do with what is usual clinical practice. Pediatricians with special training should be allowed to do this as well.
Roughly 30 percent of children with autism will have a seizure disorder. These children should see an epilepsy specialist.
Gastroenterologists (mouth and stomach to anus): There is a difference of opinion as to whether there is a specific “autistic gastroenteropathy” or that kids with autism will get some of the same gastrointestinal disorders as other kids get but have a harder time getting diagnosed. Kids with autism can have significant and impairing stomach disorders and should see a specialist, if possible. When kids cannot communicate their pain it is a challenge to identify that something is wrong. That job often falls onto the parents. Should all kids see a GI doctor? I don’t think so.
Allergists/Immunologists (sensitivity to environmental factors such as allergies and infections): Allergy and immune disorders are two controversial areas in autism. There continue to be challenges on how to properly assess them. Personally I am cynical about the several specialty labs around the country that specialize in exotic assays of immune factors and heavy metals or even neurotransmitters in the blood or urine, having gotten back different results and recommendations from the same sample sent to different labs.
Some kids who have positive laboratory findings to a particular protein (plant or animal) or substance may not show clinical symptoms when exposed to that substance. Some kids will test negative to something but are highly sensitive to it in the environment and consistently and repeatedly show clinical or behavioral symptoms when exposed to it. Sometimes the only way to sort out what is real is to do carefully controlled elimination diets and that isn’t always easy.
Next: The role of early intervention.
Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.
The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.