HJAR Mar/Apr 2025

AUTISM CARE 16 MAR / APR 2025 I  HEALTHCARE JOURNAL OF ARKANSAS 6. Anxiety and Depression Anxiety and depression are common in children, and their symptoms can over- lap with autism. Social anxiety may cause avoidance of new social situations, and depression may result in social withdrawal. However, children with anxiety or depres- sion often maintain social skills in familiar settings. What to do: • Screen for anxiety and depression if there’s a family history of these condi- tions. Evidence-based parent training interventions are recommended, with medications if necessary. 7. Environmental Factors: Neglect and Trauma Neglect and abuse can lead to develop- mental delays, particularly in speech and social skills, which may resemble autism. Children exposed to trauma may adopt coping mechanisms, such as withdrawing or remaining silent. What to do: • When neglect or abuse is identified, connect the child with therapeutic support. Many children show signifi- cant improvement with early inter- vention. If atypical behaviors persist, a comprehensive autism assessment is necessary. 8. Social Pragmatic Communication Disorder This condition, distinct from autism, involves challenges in using language appropriately in social contexts. While chil- dren with Social Pragmatic Communication Disorder have age-appropriate language, they struggle to adjust communication to fit social situations. What to do: • A detailed developmental history can help differentiate social pragmatic communication disorder from autism. child hasn’t been screened in the last year. • Arkansas’s Early Hearing Detection & Intervention (EHDI) program offers resources. 3. Vision Impairment ASD often involves difficulty with non- verbal communication, such as eye contact and visual cues. Vision impairments, espe- cially in pre-verbal children, can complicate autism evaluations. What to do: • A comprehensive vision assessment by a pediatric ophthalmologist is crucial, especially for children born prematurely. 4. Sensory Processing Disorder (SPD) Many children with sensory process- ing difficulties exhibit symptoms similar to those seen in autism, such as sensitivity or a strong desire for specific sensory experi- ences. However, SPD alone does not include the social communication challenges that define autism. What to do: • Distinguish between SPD and autism by considering the presence of social- emotional reciprocity deficits. 5. ADHD (Attention Deficit/ Hyperactivity Disorder) ADHD is the most common neurobehav- ioral disorder in children, with an 11% prev- alence in the U.S. 4 Around 14% of children with ADHD also have autism. 5 Both condi- tions share social skill deficits but differ in that ADHD does not include the restricted and repetitive behaviors typical of autism. What to do: • Manage ADHD symptoms through behavioral supports and, when nec- essary, medications. These interven- tions often improve social awareness and peer relationships. Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by persistent challenges in social-emotional reciprocity and the presence of restricted, repetitive behaviors, interests, or activities. These traits often impact social interactions, communication, and daily functioning. The American Academy of Pediatrics recommends routine autism screening at 18 and 20 months during well-child visits using autism-specific tools. 1 However, sev- eral other conditions may share features with autism and need to be considered to ensure proper support for children and families. This guide covers the most com- mon differential diagnoses to consider when evaluating a child for autism, as well as rec- ommendations for early interventions. 1. Developmental Delay Developmental disabilities affect 1 in 6 children aged 3-17 in the U.S. 2 Children with delays in speech, language, or social com- munication may appear socially withdrawn. However, their social skills tend to develop along with other developmental milestones. What to do: • Use broad developmental screeners to assess delays. • For children under 3, refer to early intervention programs likeArkansas’s First Connections. • If early intervention isn’t an option, consider referrals for speech, physi- cal, or occupational therapy. 2. Hearing Loss Language and communication depend on a child’s hearing. In 2022, 1.7 per 1,000 babies were identified with hearing loss through newborn screening. 3 Premature birth, CMV exposure, or genetic conditions increase the likelihood of hearing loss, which can delay language development and mimic autism- like behaviors. What to do: • Refer for a formal hearing test if the Differential Diagnoses in Autism: What You Should Know By Shruti Tewar, MD