News and Views from kSero
Will screening for Childhood Disorders create an epidemic of overdiagnosis?	March 1, 2008
Reviewed by Molly Reams The American Academy of Pediatrics has created guidelines standardizing screening for autism spectrum disorder during regular checkups. This practice has some psychiatrists worried about "overdiagnosis" of children who fall in a marginal range of normal behavior but may be grouped among the increasing rate of diagnoses made by physicians trying to catch problems early. Autism cases have exploded in recent years, with the CDC estimating that one in every 150 children has an autism spectrum disorder. Experts and others question whether there is an actual increase of autism among the population, or if we are more highly sensitized to recognizing the disorder. Richard Friedman, a child psychiatrist at Weill Cornell Medical College agrees that there is a worry for overdiagnosis, but that many severe cases go untreated, and screening for this disorder may help kids who have a potentially treatable illness. The potential dangers of such a diagnosis include stigmatization, and inappropriate use of health care services. Often, referrals to specialists in neurodevelopmental disabilities are necessary for such problems. Paul Lipkin, a developmental pediatrician at the Kennedy Krieger Institute, will often see such referrals. There have been cases where, after a complete evaluation, he has determined the child to have only mild problems and nothing that might be considered on the autism spectrum. One perspective is that the family ultimately was provided with information to help them better understand their child. However, it is a concern that the families may begin to worry unnecessarily about a diagnosis before a full evaluation has occurred. In this case, the family may perceive the child as being very different in some manner, when in fact, the symptoms are very mild. In addition to the new screening methods for the autism spectrum, there have also been callings for universal screening for depression in adolescents. This would present a similar problem with stigmatization, and may unnecessarily upset the parents and child. Richard Friedman points out that you need to take perspective when examining this process. Is it okay to upset someone temporarily in an effort to prevent illnesses from going untreated? "Stigma doesn't kill," Friedman says, "But untreated psychiatric illness can kill, and untreated depression can certainly kill." Source: The Dana Foundation's Brain Work, Vol. 18 No.1 January-February 2008