The moment the adolescent boy greeted and hugged me, I could barely believe it was him. The Allan I remembered had refused to make eye contact and was unable to sustain a conversation or engage in age-appropriate social imitative play. As a young child, he immersed himself in repetitively reorganizing his baseball cards or constantly taking some electrical or mechanical object apart to "see what was inside" so he could "fix" it. Yet this was Allan, the autistic boy I met years ago, who was now 13 years old and standing in front of me.
Some of us in residency may not yet have experienced working with an autistic child. Epidemiological studies suggest the prevalence of autistic disorder is two to five cases per 10,000 children. However, with some studies indicating that the diagnosis is possibly on the rise, it is likely we all will deal with autism at some point. Thus, it is vital for us to understand the disease, its diagnostic features, its various levels of developmental delays, the course of the disorder, and effective treatment recommendations.
One of the most significant components in improving the quality of the lives of children with autism is early diagnosis. By definition, the onset of autistic disorder is prior to age 3. In the past, when the diagnosis was made in elementary school, the child was likely removed from that environment, secondary to impaired social interaction and deficiencies in communication. With earlier diagnosis and the consequent earlier implementation of effective interventions, the prognosis for the child to achieve maximum potential is improving.
Residents may wonder how they can help these autistic children reach their full potential and positively affect their lives in the little time they have interaction with the children. The good news is that one of the most important things we can do is to initiate the early involvement of collateral medical disciplines and appropriate agencies through the referral process. This will help ensure the children have the opportunity to achieve the highest level of development through interaction with a multidisciplinary team.
As residents, it is important for us to conduct a thorough physical examination and check the child's daily lab results, but we should also get occupational and physical therapists involved. They can often help expand the child's world by increasing the opportunity for sensory experiences. We should also enlist the skills of a speech therapist, who can assist the children in acquiring the necessary skills for learning language and expressing themselves in meaningful communication.
We need to offer a realistic optimism to parents when discussing evaluation results and presenting care plans, but we should also ask for a social worker's assistance. The case worker can provide referral information for collateral supportive agencies that can help the child, and tell the the family how to get involved in early intervention that offers real solutions for integrating the autistic child socially (eg, group activities for children with special needs, such as summer camps, horse riding stables, art classes) and academically (eg, working with a school's counselor in developing an individualized education plan to meet the child's specific strengths and challenges).
Through earlier involvement, we can help children with autism reach their full potentials. They may never be capable of independent living, but they can maximize the quality of their lives and the contribution they makes to the society within which they interact. Working with autistic children certainly presents the resident with unique challenges, but the work offers the wonderful benefit of a front-row seat for observing development and growth. This growth may be measured in small increments of progress but yields a large dose of satisfaction.
Allan now lives semi-independently in his own home with a house supervisor, occasionally goes to a movie with a friend, works part-time as a custodial assistant at the local high school, and is very proud when he cashes his paycheck, some of which he spends on his baseball card collection. He wanted me to ask if any of you had a broken radio, fan, or clock that he could have so he can "fix" it.