1 . The primary aim of the study was to identify
which behavioral characteristics of autism are apparent in early
childhood in order to assist pediatricians to make an early diagnosis.
Given this objective it was important to include only young children
and hence we have deliberately selected children below the age of 5
years. It is important to recognize that autism is associated with a
tremendous range in syndrome expression, that is, symptoms change over
the course of development and in relation to the degree of associated
mental retardation(2,3). Given this, it is important that
pediatricians be aware of the range of syndrome expression especially
in young children since they are the only professionals who have early
and continued contact with most children and thus have the greatest
opportunity to recognize this disorder in early life(4). However, the
recognition of autism is often delayed(1). Some of the reasons for the
delay include low prevalence, lack of awareness, changing
characteristics with age(5,6), symptoms that overlap with other
conditions, especially mental retardation and hearing and speech
disorders. In addition some signs of autism are less common in very
young children(1,6), while other signs are seen in very young children
but disappear as the child grows older. If the criteria for autism are
strictly applied, it is quite possible for young autistic children to
be underdiagnosed.
2. As has already been mentioned in the article it
is not meant to be a prevalance study. The very fact that we had 16
cases over a period of about two years (and have subsequently seen
many more) shows that the condition is not uncommon, but is
underdiagnosed.
3. Several authors have reported that about one-fourth to one-third
of parents of children with autism report regression of their child’s
language, social and play skills, most often before the age of 2,
followed by a prolonged plateau and eventual improvement but not
full recovery(7,8). This autistic regression is not to
be confused with disintegrative disorder. Our results also indicate
that 25% of parents of children with autism reported that early
developmental of their children was normal and at around 18 to 24
months of age their children underwent a behavio-ral regression in the
language area. This regression can be distinguished from childhood
disintegrative disorder wherein a prolonged period of normal
development is followed by a marked regression in multiple areas. In
Rett’s disorder, very early growth and development is normal but is
followed by a deceleration in head growth, development of marked
mental retardation and unusual hand-washing stereotypes, which are
characteristic.
4. Dr. Gupta perhaps needs to look at recent
studies in the literature which have specifically examined the
defining clinical features of autism in children as young as 3
years(3). These studies based on larger sample sizes than ours also
argue against the applicability of autism criteria with regard to
language abnormalities and a need for insistence on routines in young
children with autism.
5. The objective of the study was not to compare
the clinical profile of children with various types of PDD as
suggested by the author. Moreover, our results are clearly in
cognizance with previous literature (studies with larger sample sizes)
as clearly mentioned in the paper and therefore Dr. Gupta’s caution
about the generalizability of results is misplaced. Infact a
subsequent study (unpublished) based on a larger sample size supports
out previous generalizations.
