Cerebral Palsy Diagnoses, Easy?

The mother of one of the children being treated at my clinic phoned, quite upset. Usually, calm words quell a parent's fears in such conversations, but not in this case.

"Please, check again whether my child is autistic," she pleaded.

Her 4-year-old son is developmentally delayed, and it is still unclear whether this is due to an autistic disorder or whether, in the future, he will be able to catch up to his peers and function completely normally. His mother has already taken him to many specialists, both privately and through the associations that treat autistic children, but has received contradictory opinions.

Some doctors have diagnosed him as suffering from an "autistic spectrum disorder," while others have ruled this out.

Recently, for example, the mother was advised to begin therapy with her son that costs about NIS 5,000 a month. But is the treatment necessary? Pediatricians must first verify that a child is not suffering from impaired hearing or a dysfunctional relationship with his parents. If a child has a hearing impairment, a hearing aid or surgery could prevent his deterioration to a state of delayed development. If a child is ignored by or has poor relations with his parents, appropriate psychosocial therapy can improve his behavior and prevent behavioral disorders at a later stage. If, on the other hand the problem is genetic, this can be detected during pregnancy. According to various data, autism occurs in 20-60 persons in 10,000.

There is also a socioeconomic and somewhat paradoxical aspect to the determination of the diagnosis. In Israel, the state allocates more resources to autistic children than those with other developmental delays or cerebral palsy, which are not always included in the criteria for "disabled" recognition, and as a result children suffering from other disorders do not receive stipends or eligibility for rehabilitative care.

Autism, like other disorders, has varying degrees of severity. Some people with autism are completely non-communicative with their surroundings, while others are less severely affected and relate to their surroundings on a limited level. Still, as long as a child is diagnosed as being within the autistic spectrum, he is eligible for full financial assistance. This helps little in the worst cases, but is wonderful for mildly affected children, who will respond well to treatment.

The health care and education systems do not make a similar effort for children suffering from other developmental delays or cerebral palsy. Still, they need the same intensive therapeutic intervention and do not receive it during their early childhood years, which are so critical to their development. Sometimes they are eligible for assistance only after age three, or even later. Children with mild to moderate delays or cerebral palsy aggravated by environmental deficiencies are the very ones who will not receive anything - neither a disability stipend nor a rehabilitative educational framework (children with Down syndrome are the exception, as they are recognized as developmentally challenged from birth and do receive state assistance).

The reason for this disparity lies in the way these disorders were viewed by past lawmakers. Developmental delays and cerebral palsy were not defined as disabilities before age three, due to the attitude that until that age a child needs assistance anyway, and is not independent. As for autism, formerly it was defined as a mental illness, so a diagnosis immediately earned a child with autism recognition as disabled and eligible for a stipend. It was only following intense public effort that such rights were granted to other disabled children, but many still remain outside the system.

I reexamined the child whose parents had brought him to my clinic. He smiled at me, asked questions, showed me what he could do, and shared his joy at successfully focusing on certain tasks for a few seconds at a time. I sighed and turned back to the parents. I could not help them, I explained. The therapy staff and I concurred that this child is not suffering from autism.

Although this is good news, it also means the parents would not be eligible for assistance from the National Insurance Institute. The therapy that had been suggested to them might be very effective, but the state would not cover its cost.

The parents looked lost. They had heard so many opinions. Perhaps someone else would write a suitable letter for them to the NII.

Still, why should this child be any less eligible for assistance? Perhaps the time has come to change the criteria, to examine the children's needs and not the scientific diagnosis; to allocate appropriate budgets for all developmental disorders. If the pie has to be divided among all children, varying levels of disability will have to be defined, and since these are small children, they will have to be periodically reevaluated. Additional therapy frameworks are also needed, with broader admission criteria.

Dr. Posner is a pediatric neurologist and director of the Community Child Development Center of Clalit Health Services.

source: Haaretz

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