Case Study: Is it Autism?
Autism, as with many mental conditions, is sometimes difficult to diagnose. Conventionally, we look at a patient’s symptoms and try to pair the symptoms to a condition. Many times, this can save lives and prevent suffering. But one has to ask, is an approach appropriate for saving lives equally appropriate to caring for the health and well-being of others?
The Diagnostic and Statistical Manuel of Mental Disorders, 4th Edition (DSM IV) was the gold standard for mental diagnoses in the United States for years. Broadly speaking, it made it so that many people, who previously would not have been seen as having a mental condition, were now able to be classified. This approach is both good and bad. Good in the sense that many people received the help that they normally would not have been able to receive, but bad in that many were misdiagnosed.
Enter patient Ethan*, age 5.
Ethan’s parent had been coming to the office for sinus pressure and headaches for some time. During the occasional visit, Ethan’s parent would tell me that he was a special needs child. At one such visit, it was learned that he was, in fact, diagnosed with autism. Being a particularly nosey doctor, I inquired as to his symptoms: not making eye contact, no desire to use complete sentences, no desire to participate in social activities, and generally disruptive on a whim. All could be reasonably described as autistic behavior, but not without doubt.
Eventually, I met Ethan. He was exactly as described; however, I still was not convinced that Ethan truly had autism. I have personally seen what happens to children who are misdiagnosed with a condition that they truly did not have and the stress it puts on a family. So I figured I owe it to all children to give them the opportunity to reach their potential, and after receiving parental consent, I began my examination of Ethan.
Everything seemed to be looking like mild/moderate autism, except for one important factor. His right cheek was inflamed. Upon asking Ethan’s parent if he had recently had a sinus infection, I learned that he indeed had. Three months prior, he had been diagnosed with autism, and six months prior, he had suffering from a big COLD (rhinovirus).
When the initial treatment was completed, we rescheduled for a week out. One week later, Ethan was making eye contact and would not stop talking about EVERYTHING! I learned that exactly 20 minutes following my initial treatment, Ethan scrambled for a handkerchief and released a golf ball size mass of snotty discharge. It would seem as though the medications he’d taken to stop the sinus infection also stopped Ethan’s nose from draining. Loosening up his cranial bones around the sinuses allowed drainage to take place quickly.
Several months later and Ethan is still going strong. He has even gone so far as to express his desire to be an engineer.
It is vitally important to remember that not every diagnosis is exactly what it appears to be. Many times, the first impression is correct, but when the future of our children are at stake, a second opinion might be all it takes to return to a better life.
*In keeping with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the patient’s name has been changed.