"There are other reasons why a sizable percentage of toddlers get erroneously diagnosed with autism spectrum disorder. Up to one in five two-year-olds are late talkers. They fall below the fifty-word expressive-vocabulary threshold and appear incapable of stringing together two- and three-word phrases. This sort of irregular language development is one of the hallmarks of early autism. Yet it is notoriously difficult to distinguish between toddlers with autism spectrum disorder and those who are afflicted with delayed language development. The situation is further complicated by the fact that toddlers with delayed language development tend to share other features in common with autism spectrum children. Scientific findings at the famed Yale Child Study Center have shown that toddlers with delayed language development are almost identical to their autism spectrum disordered counterparts in their use of eye contact to gauge social interactions, the range of sounds and words they produce, and the emotional give-and-take they are capable of. Consequently, many toddlers who simply don’t meet standard benchmarks for how quickly language should be acquired and social interactions mastered are in the autism red zone.
Expanding autistic phenomena to include picky eating and tantrums only amounts to more confusion when applied to toddlers. The percentage of young children in the United States with poor appetites and picky eating habits is so high that experts writing in the journal Pediatrics in 2007 commented, “It could reasonably be said that eating-behavior problems are a normal feature of toddler life.” Tantrums also are surprisingly frequent and intense during the toddler years. Dr. Gina Mireault, a behavioral sciences professor at Johnson State College in Vermont, studied children from three separate local preschools. She discerned that toddlers had tantrums, on average, once every few days. Almost a third of the parents surveyed considered their child’s tantrum behavior to be distressing or disturbing.
With the push to screen for and detect autism spectrum disorder at progressively younger ages, the risk is greater that late-talking, picky-eating, tantrum-throwing, transition-resistant toddlers will be misperceived as potentially autistic—especially if an evaluation is conducted in which the child is not sensitively engaged and put at ease. The risk is more acute, as I will soon illustrate, if this toddler is likely to develop into an introverted, cognitively gifted boy who tends to be single-minded and willful in his approach to life learning. Even more basic than that, if we don’t have a firm grasp of gender differences in how young children communicate and socialize, we can mistake traditional masculine behavior for high-functioning autism."
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