LAUSR

In the 38 children in the sample, and in our system in general, we do attempt to address each of the above issues fully through the availability and input of an interdisciplinary team. The children in this sample were 2þ years of age at the start of the study and were too young to be evaluated and diagnosed with learning disabilities and most emotional-behavioral diagnoses. (They were all however diagnosed with developmental delay based on developmental testing.) But they were evaluated by a multidisciplinary team able to do that rather than a team charged with simply providing feedback on autism—yes or no. Bringing the multidisciplinary expertise to the process of both initial diagnosis and follow-up allows each child to be evaluated for all relevant diagnoses initially and thereafter. At follow-up, utilizing the information from across settings (home and school), observations in clinical sessions, and standardized measures (ADOS and CARS), the children did not meet ASD criteria, but their various language, learning, and emotional/behavioral needs were able to be characterized by school age. Regarding your more general comments about the ASD diagnostic process, you raised concerns about how “factors such as support and funding may impact diagnostic decisions.” We too recognize that factor. We have seen well-meaning clinicians attempting to help families obtain more intensive services by diagnosing ASD in instances where other diagnoses apply, and parents seeking an ASD diagnosis for the same purpose. We attempt to make the process of ASD diagnosis as standardized and objective as possible, and the backbone of that mission is making diagnoses of ASD based on observed behaviors across sessions and feedback from all settings where the child spends time. The use of the ADOS (for borderline calls or situations where observations are at odds with reported behaviors) allows us to attempt to elicit capabilities/deficits relevant to the diagnostic formulation. We agree that reliance on checklists completed by parents or school are often insufficient for a valid ASD diagnosis. Regarding the importance of language in shaping parental expectations, on this too we agree. The main point of our article is that though ASD symptoms (significant social communication and restricted repetitive behaviors) had resolved according to all available sources and based on objective instruments, the majority of the children had ongoing learning and emotional behavioral needs requiring IEPs and intervention. Considering the early diagnosis of ASD as a significant risk factor /“red flag” for future learning and emotional or behavioral diagnoses even when the child does well from a social and restricted repetitive interests perspective is appropriate. Children with early diagnosis of ASD will change over time, their needs will change, and they should be monitored and their interventions individualized to meet those needs.