978-1572305441

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took the second, and currently more common, approach: He delayed
giving the diagnosis as long as he could since the clinical presentation
was not “classic.” He did not know there is no such thing as “classic”
autism anymore. The enormous variation in clinical presentation in
autism, the fact that the clinical picture changes over time, and the realization
that there are other forms of ASD that share some features with
autism but may look different is perhaps the most important advance in
the science of ASD over the last two decades.
Most parents notice something not quite right with their child’s development
within the first two years of life. Often, however, they do not
receive a diagnosis until five or six years of age. Making a diagnosis earlier
is difficult, but we are learning more and more about the very early
signs of the disorder. As this new information percolates down from the
researchers to front-line clinicians, one can only hope that these delays
in receiving a diagnosis can be eliminated. Perhaps the most important
finding is that the early diagnosis relies heavily on an assessment of
social–communication skills in young children. Toddlers with ASD infrequently
show the range of repetitive stereotyped behaviors (rocking,
rituals, resistance to change, spinning wheels, etc.) more commonly
seen in older children. Too often, the diagnosis of AS does not come until
even later, at eight or nine years of age. Family doctors, not yet aware
of this new information, try to reassure parents that their initial concerns
about social and communication skills in infancy and toddlerhood
are the results of too much worrying, of having a first child, or of
sheer lack of knowledge about child development. This reluctance to
give a diagnosis early on leads to significant delays in getting children
into early intervention programs. Some children who start these programs
at five or six years of age have less prospect of improvement than
if they could start receiving therapy much earlier. There are few more
frustrating experiences for parents than to be told first they are too worried
about their child’s lack of speech and then, two years later, that he
has autism but now the waiting lists are too long to receive timely interventions.
Clinicians have tended to overlook the fact that we’ve had reports
of good outcome among some children with autism for decades. Kanner
titled one of his last papers “How Far Can Autistic Children Go in
Social Adaptation?” In this 1972 paper, he reported on the “best outcomes”
among the first ninety-six children with autism seen at his
clinic. He identified eleven (out of ninety-six) who he felt “ functioned
gainfully in society.” Indeed, the case studies show remarkable improve-