Thomas Sowell on False Diagnosis and “Genuine” Autism

Autism is being overdiagnosed, says conservative thinker Thomas Sowell in Crusades Versus Caution, Part II, in which he suggests that the recent call for universal autism screening of children aged 18 to 24 months will lead to unnecessary alarm among the parents of young children. Sowell, a fellow of the Hoover Institute, writes that parents are being advised to get an autism diagnosis only for a child who is a “late talker” or displays some of the diagnostic criteria for autism, and only in order to access services. “Many parents have told me that they have been urged to let their children be labeled autistic, or on the autistic spectrum, in order to get money for speech therapy or other conditions from grants that are available to deal with autism,” Sowell notes. Sowell cites Professor Stephen Camarata of Vanderbilt University who (says Sowell) has seen many children with “inaccurate diagnoses”:

There is already considerable evidence of false diagnoses of preschool children as autistic, and the treatments inflicted on them can be abusive, with incalculable negative effects on their development.

What about the positive effects of “early intervention”?

According to Professor Camarata, those children “with true autism” are “very difficult to treat and may never say ‘mommy’ or learn to take care of themselves without Herculean efforts by their parents and teachers.”

The limitations of what can be achieved with even early intervention mean that there can be real heartbreak, whether a toddler or preschooler is either falsely or correctly diagnosed as being autistic.

Sowell points to the changing, and broadening, of the diagnostic criteria for autism and the tendency to describe a child as “on the (autism) spectrum,” rather than saying that they “have autism.”

While there are some conditions which are much like autism, there are other conditions, such as having a very high IQ or simply being late in talking, which often include characteristics listed on checklists for autism. These are open invitations to false diagnoses.

We would see the dangers immediately if people who wear glasses were included on “the blindness spectrum” or people with harmless moles were included on “the cancer spectrum.”

Blindness, cancer and autism are all too serious — indeed, catastrophic — to use loose definitions that fudge the difference between accurate and inaccurate diagnoses.

Loose definitions of autism produce bigger and more newsworthy statistics, which in turn can attract more children into existing programs and attract more money from the government, foundations and other sources to support those programs.

I see where Sowell, whose books include Late-Talking Children and The Einstein Syndrome: Bright Children Who Talk Late, is coming from. Having a speech delay is not a necessary harbinger of autism—indeed, while Charlie’s not talking when he was a toddler was a first sign of autism, it was his lack of joint attention, his sensory responses, and his restricted play that were most indicative of “something wrong.” But Sowell’s comparison of the “autism spectrum” to hypothetical spectra of blindness and of cancer is not an accurate analogy. A child who is “very bright” and who “talks late” can still not only need special services, but may lack social skills and not have friends or be able to attend classes without an aide; he or she can excel academically, but have great difficulty being in a classroom with the children his or her age. While not every student requires services ranging from speech therapy and OT and PT and a 1:1 student:teacher ratio, just saying their needs are “not a big deal” is something I would think school administators would like to hear. But what happens when a student cannot learn because he struggles so much in a classroom? Because she is bullied? Because people say that “understanding the material” is the criteria for “doesn’t need any extra help”? My years of teaching have shown me that students can understand the subject matter, but so many other realities—-trouble being organized and knowig how to study a lot of material, to note a few things—can impede their learning and, ultimately, their success in school and beyond.

When my son was not talking back in the winter of 1998, friends of the family insisted that we read Sowell’s Late-Talking Children. I am sure that different families have different experiences, but this book was not Charlie and a conversation with the friends—-whose grandson had talked late—confirmed that his was a very different situation. A friend has a son who she describes as having “Einstein Syndrome”; far from leaving him to his own devices, my friend schedules her work around his school schedule (he is in high school), meets with every teacher regularly, and, last summer, had to devise sometimes elaborate activities to keep him busy (her son needs the structure and does not get any school services in the summer).

Sowell’s cautionary words about the potential for over-diagnosis of autism are well-taken, but, in his criticizing of universal screening for autism and his questioning of early intervention, it might be said that he is on a sort of crusade of his own. I can say that I can somewhat join him in critiquing early intervention, though for different reasons: To me, the term “early intervention” suggests that if a parent does not do everything he or she can to get a child to start talking and catch up to his peers developmentally by a certain age, this will be (in Sowell’s words) “catastrophic.” I would rather say, education for my son Charlie and kids like him is a lifelong process that requires a lot of specilized teaching and services and that takes as long as it takes and that we need to think beyond early intervention. Each to his own sweet time.