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May 22, 2009

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Bopha

Great points! In my exinrpeece as a pediatrician, speech delay in the under-three crowd can be caused by a plethora of things. There is even a subset of extremely high functioning normal kids who wait to speak until they have almost an adult level of vocabulary and syntax and then wake up one day and say, Mommy, may I please have oatmeal for breakfast today? I'm not kidding, I've seen it. But they were slapped with an ASD diagnosis before that.The only really reliable cues to a true severe autism diagnosis that I have seen are 1) what I call a starfish baby whose limbs actually stiffen when held instead of cuddling up; and 2) avoidance of eye contact in a seeing child. These children require special EEG testing to make sure they are not blind. They will often follow objects, however. I've seen kids like this who will lie on their backs in their cribs watching their mobiles for hours and hours, but will not make any eye contact whatsoever.Your point about ADHD is also well taken. That's where home visits are very instructive. Are the parents couch potatoes and they happen to have an athletic and bright kid who simply needs a lot of physical activity and/or intellectual stimulation?Then there's the subset of ADD kids who are actually bipolar. In my practice I caught several of them. The tipoff is when these kids are treated with stimulants, they become weepy and depressed. You treat them with either an anticonvulsant or Lithium and they feel much better and function better at home and in school.It's unfortunate that the art of medicine is really no longer taught. It's distressing to see the decline in quality of the pool of physicians, as the generations of docs who knew and taught the art are retiring or, like myself, leaving for other reasons.

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