Is it autism? Or is it something else?
Your child is struggling with schoolwork or school behaviors. He has trouble making and keeping friends or doesn’t even bother to try. Or he insists on fried chicken fingers for every meal and won’t try much else. And now he isn’t able to sleep through the night.
It could be autism. Or it could be a number of other developmental conditions with similar symptoms, said Ioana Pal, Psy.D, a licensed clinical psychologist at the Stramski Children’s Developmental Center at MemorialCare Miller Children’s & Women’s Hospital Long Beach.
“Attention Deficit Hyperactivity Disorder (ADHD), birth defects, fetal alcohol spectrum disorder, early trauma — like abuse or neglect and even genetics — are conditions that can cause developmental delays and behavior problems,” Dr. Pal said. “It takes detailed clinical investigative work to determine exactly what condition is causing the difficulties to offer the treatment most beneficial for the child and family.”
Dr. Pal is a member of the Stramski Center’s Behavior & Neurodevelopment Program team, one of six specialized clinics offered with an abundance of referrals for children with various developmental issues. The clinical team — composed of psychologists, developmental pediatricians, nurse practitioners, and specialized nurses — collaborate to establish the diagnosis, treatment goals and recommendations, and make appropriate outside referrals for improved functioning.
As a team psychologist, Dr. Pal begins by interviewing all the adults in a child’s life, from parents, to teachers, as well as therapists working with the family, who can describe behaviors, preferences and routines.
The background interviews are followed by in-person interaction with the child and several questionnaires and standardized tests.
”I try to get a lot of information, to help me clearly see all the pieces of the puzzle,” said Dr. Pal. “The evaluation is a complicated, nuanced process. Every child is different. Some children with language problems might only need speech therapy. Some present with anxiety. You don’t want to label a child as on the autism spectrum if he does not meet the criteria for autism spectrum.”
The finished evaluation includes a diagnosis and specific data points that can help parents avoid delays in qualifying for community and special education programs along with early intervention therapies.
“Autism can be identified as early as 18 months in some children,” Dr. Pal said. “It is a neurodevelopmental disorder that affects communication, socialization and behavior. Children diagnosed with autism (ASD) experience the world a little differently and it is important to understand them.”
“Some show red flags early, some around ages 2 or 4,” said Dr. Pal. “Others function well until middle school. But by then, characteristics such as inflexible thinking may be harder to modify. That is why ideally evaluating a child early leads to best outcomes.”
One patient diagnosed with ASD, for example, is a 16-year-old who is bright, excels in academics and sports, and fills spare time with hobbies and a job. “She doesn’t have a lot of friends, maybe because she can be blunt, and says exactly what she thinks, although not intending to be rude and insensitive,” Dr. Pal said. “We know there are things that are socially inappropriate. However, without a diagnosis and interventions we may say she is quirky and unable to know if and when she may be insensitive.”
“Part of the intervention is teaching self-awareness, to look at other people from a different perspective, and to see themselves as others see them, which can be difficult for those with an ASD diagnosis,” says Dr. Pal.
“The most important thing about our mission is that we do it right the first time and set the child up for success.”