Your Voice

February 1, 2009

Recent letters from Contemporary Pediatrics readers.

The risk in early diagnosis

Thank you for the summary article on autism spectrum disorders (October 2008), which was succinct and very well done.

I am writing about two inter-twined points:

With the recognized need for early recognition and value of early intervention, there is sometimes a rush to diagnosis. Especially in borderline or marginal cases, my experience has been that the early application of a significant diagnosis may result in more long-term harm than good. If our early intervention therapy is successful and normalizes the child's functioning, then we have a child who is doing well but left with a label that is hard to remove. Future educators working with this child, and even parents, will often approach this child as still being "damaged" goods.

Using Dr. Mel Levine's strategy of diagnosing and labeling the problems, rather than the child, gives us the advantage of treating the problems and evaluating the child's progress without applying a label with long-term negative implications.

Positive expectations are often self-fulfilling. But negative expectations unfortunately are especially so.

George Starr, MDSyracuse, N.Y.