ARE YOU SURE IT'S A DEVELOPMENT DISORDER OR A LEARNING DISABILITY?

This is the medical story of Brian, a delightful 6 year-old who I initially evaluated in April 2000.

His mother's main concerns were Allergies, Developmental Delay, and Auditory Processing Disorder.

Brian developed frequent ear infections between 2-1/2 - 3-1/2 years. From 3-1/2 - 5 the ear infections improved, but there were almost monthly episodes of sinusitis.

Of major concern was Brian's speech delay. After saying several words by 15 months of age, language came to a standstill. He was evaluated by a number of specialists with different assessments giving typically different answers. Diagnoses included Dyspraxia, Genetic Delay, Auditory Processing Disorder, and Developmental Delay.

Other developmental issues included low motor tone, flapping arms while jumping, and fine motor delay. There were also sensory integration issues including sensitivity to sound, and high pain threshold.

The allergy history was remarkable. There is a history of perennial allergies with a mild increase in the spring and fall and damp weather. Nasal allergies included stuffiness and mouth breathing. Dark circles were noted for at least 1-1/2 years prior to the initial office visit. Post-nasal drip resulted in a persistent cough at night. Brian also complained of sinus headaches and of major concern was severe fatigue described as a lack of stamina.

The speech therapist who referred Brian to me observed that with increased dark circles, there was a consistent increase in fatigue, nasal allergies, low muscle tone, pale color, glassy eyes, decreased alertness and activity level, and inconsistent performance. He was described at times as looking like he was, "in a coma".

Autistic behaviors included decreased eye contact, jumping if excited, and delayed social skills.

Brian's food cravings included 4-5 glasses of milk daily as well as a craving for yogurt and cheese.

Physical examination was normal except for the appearance of allergic shiners and pale nasal membranes consistent with allergies.

At the follow-up visit in July 2000, I was delighted with Brian's improvement. Problems with recurrent sinusitis, dark circles, eye contact, language, nasal stuffiness, and runny nose, post-nasal drip, headaches, energy level, alertness, muscle tone and glassy eyes had all significantly improved. His mother noted that now he will say, "I am bored". Prior to being treated for his allergies, he would just sit in front of a T.V. for days. Brian will now let his parents know when he is excited or mad. Peer relations have also improved. Prior to April he never wanted to play with other children. He is now playing with his older cousins and a 5-year old in the neighborhood.

For the past ten years, I have seen an alarming increase in a number of children who are diagnosed with Autism Spectrum Disorder and Pervasive Developmental Disorder.

Brian is a wonderful example of a child who never really had Autism or PDD but was paralleling that medical history with difficulties with language delay, decreased eye contact, social skills, and underachievement in academic performance. By eliminating cow's milk from his diet and starting appropriate immunotherapy to control his allergies to dust, pollen, molds and foods, there has been a tremendous turnaround in only three months.

I personally have found the diagnosis of Autism Spectrum Disorder to often be vague, but there is a significant percentage of children with developmental delay issues who are impacted by their allergies. In Brian's case by avoiding milk and getting his allergies under control, he is doing so much better physically, behaviorally, and developmentally.