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Would you tell your best friend that his kid needs to be evaluated for autism?

Discussion in 'Emergency Medicine' started by Angry Birds, May 14, 2016.

  1. Angry Birds

    Angry Birds Angry Troll 5+ Year Member

    Dec 4, 2011
    So my best friend (and pretty much my only real close friend) has a two year old son. I've been observing this child for about that amount of time. I'm 90 percent certain the kid has autism. I've dealt with enough autistic kids in the ER to know. I even looked up autism screening tests done by pediatricians and did it on the kid, and the result was "high risk for autism." I did the same test on another child of similar age as a control test, and it was "low risk."

    Anyways my friend seems totally oblivious to his son's problem. I think he is the type of person to deny anything is wrong until the last possible moment. I also fear he would kill the messenger. Being that he's my best friend I'd hate to be that messenger.

    What would you do in this situation? Especially those of you who have kids (as I don't have any yet)...

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  3. goodoldalky

    goodoldalky Member 10+ Year Member

    Jul 6, 2006
    Probably not your place to say unless asked, and ideally addressed by the pediatrician (perhaps it has already been addressed, and your friend prefers not to share).

    Is the child vaccinated? :)
    Mr Giggles likes this.
  4. KinesiologyNerd

    KinesiologyNerd 5+ Year Member

    Aug 16, 2012
    Anytown, USA
    Considering the importance of early detection and treatment I would (try to) tell him.
    DokterMom and Mad Jack like this.
  5. HoosierdaddyO


    Sep 8, 2015
    I'd casually scatter autism awareness pamphlets throughout the house!! In all seriousness I was taught that if you feel within you're deepest heart of hearts that you are doing the right thing without any ulterior motive than go for it, but also be prepared to lose the friendship over putting in your 2 cents. Coming from the angle that you care and you only have his best interest in your heart will downplay any would be weirdness. But also just for devils advocate kinda deal, if you make him aware, he goes and gets the kid checked and it turns out that he doesn't have autism...don't be surprised if the friendship takes a different path from then on :/. Only you know the Dynamics of your friendship and is it worth losing what sounds like a really good friend over something that could totally change and benefit a kids life. If you want pull him aside and have a heart to heart about you being a friend but a doctor as well and you are just trying to the do the right thing, but deep down you are praying that you are wrong. Just go in with the mindset that no good deed goes unpunished!!
    Last edited: May 14, 2016
    Mad Jack likes this.
  6. Mad Jack

    Mad Jack Critically Caring Gold Donor Classifieds Approved 2+ Year Member

    Jul 27, 2013
    4th Dimension
    I'd tell the guy, given the benefits early intervention could have on his child's development. The flip side if it is you don't tell him, and then he finds out down the line and asks if you ever saw any signs and if so why didn't you tell him (and if not, how did you miss something so obvious? Are you a terrible doctor or something?) since it could have helped his son.
    Goro and DokterMom like this.
  7. Birdstrike

    Birdstrike 7+ Year Member

    Dec 19, 2010
    I would tread lightly. As long as they're taking the kid to a competent pediatrician for routine check ups the pediatrician probably noticed this within 3 seconds of walking in the room and likely has addressed it. The last thing you want to do is come off as the one that told someone their kid is flawed, true or not, because everyone think their kid is the best. Lol. (Which is obviously false. Because my kids clearly are the most bad-ass.)

    That being said, sometimes when you don't have kids, some stuff on the edges of the "normal" bell curve seems abnormal when it's not. Kids are weird. It doesn't always equal pathology.
  8. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor Classifieds Approved 10+ Year Member

    Oct 28, 2006
    When Dr. Cox told Ron that Nathan had autism, their friendship was tested but survived. So there's that...
  9. Druggernaut

    Druggernaut Physician Lifetime Donor Classifieds Approved 7+ Year Member

    Feb 14, 2008
    And everyone ripped on that other poster for making TV references. Maybe he was on the right track all along...
  10. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor Classifieds Approved 10+ Year Member

    Oct 28, 2006
    Scrubs references are a perfectly cromulent medical citation. Nowhere near the same as quoting ER or Grey's Anatomy...
  11. Alvarez13

    Alvarez13 PGEEE2 mediates FEEEVER 10+ Year Member

    May 29, 2007
    Beat me to the punch.
  12. medic4lyfe

    medic4lyfe 2+ Year Member

    Sep 25, 2015
    Bonus points for the Simpsons reference too.

    Sent from my SM-G930V using Tapatalk
    northernpsy likes this.
  13. Apollyon

    Apollyon Screw the GST Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 24, 2002
    What a poverish response.

    edit: my error - I thought "poverish" was a Simpsons word, as someone elsewhere on SDN, more than 10 years ago, used it. However, it is not. No offense is or was intended.
    Last edited: May 16, 2016
    medic4lyfe likes this.
  14. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor Classifieds Approved 10+ Year Member

    Oct 28, 2006
    I think I would have a hard time not saying anything. You hope the pediatrician will pick it up but there are less than stellar pediatric practices. Word choice will be critical though. "Your kid seems broken, I think he has autism" is probably not the route to go. I would try to find a red flag that can be spun in a positive way with a little stretching. Hard to give an example without knowing what kinds of behaviors the kid is displaying. "Your kid seems like he's lost in thought a lot of time and distracted from interacting with other people. He's probably just a smart kid, but EM ingrains paranoia into me. Do you or his pediatrician have any concerns about his development?"

    It's not a situation that lends itself to smooth, easy conversations. If you leave both parties an escape route, it will hopefully at least protect the foundation of the friendship...
  15. EM4life

    EM4life attending 5+ Year Member

    Jan 13, 2011
    I think that the very fact you are asking this questions suggests that your friend may not take it well. I may be in the minority here but I do not feel that it is your place to bring it up. Just kind of like if your friend is fat or if your friend has a alcohol problem or whatever, tread lightly. There is a wide variability of normal development, if you mention it and his kid doesn't have autism, he's forever going to think you don't like his kid or you look down on him. If at all possible, I would direct conversation or push him to figure this out for himself, ask him how his child is doing, ask him what kind of activities they've been up to, going on trips, going to the park etc etc. The more you talk about his kid, the more he may slowly come to the realization that there's something up. Chances are also that if you've noticed this kid is developmentally off, his family members have too, and it is much more appropriate for family to bring this up than for friends IMO.
    Mr Giggles likes this.
  16. andrek82

    andrek82 5+ Year Member

    May 11, 2012
    New York
    I think it really depends on the child, as well. Are they significantly behind their peers in verbal, social, or motor skills? If so, that might be an easier way to approach it. I know it differs from state to state, but in New York, Early Intervention is run through the counties and is a no risk referral and evaluation available for kids up to 3 or 4. After that it is covered by preschool and school districts (in NY at least). The link below is a good starter resource. I like the EI approach as it is less loaded than "I think they're autistic" right off the bat, and it can be offered as a way to improve skills. If the evaluation is scored low across the board, as you would expect in various developmental delays including autism, then at least the parents know where to start.
  17. Perrotfish

    Perrotfish Has an MD in Horribleness Physician 10+ Year Member

    May 26, 2007
    In surveys, a depressing number of supposedly competent Family Physicians and Pediatricians still aren't using the standard screening forms for autism at the 18 month and 2 year check. Without those forms the rate of detecting autism at the 2 year checkup is almost negligible. Two year olds rarely demonstrate social skills in the office, they've learned to associate the doctor with shots by then and mostly just hide in a corner.

    If the kid has passed the 2 year checkup without his physician raising any red flags then I think this is worth bringing up. Intervention gets dramatically less effective with a later start. Lots of great suggestions above on how to do it tactfully.
    DokterMom and Angry Birds like this.
  18. Angry Birds

    Angry Birds Angry Troll 5+ Year Member

    Dec 4, 2011
    Thank you all for your responses. Looks like people are split down the middle, which is exactly how I feel!

    This. I'm pretty sure that this is the case. Additionally, my friend is an immigrant and he speaks a different language at home. Therefore, I think it is likely that the pediatrician may just attribute it to language barrier. I, however, speak the same language, and I know something is terribly wrong.

    I just know that he is extremely defensive about family in general. Still can't decide whether to say anything or not.
  19. Perrotfish

    Perrotfish Has an MD in Horribleness Physician 10+ Year Member

    May 26, 2007
    Are you friends with any FPs or Pediatricians who you trust? A middle ground between telling your friend your suspicions and not addressing it might be to say something about your nonspecific 'physician paranoia' tingling and ask him to see a Primary care friend of yours. You can tip the PCM off to your suspicions and they can talk to Dad about the possible diagnosis.
  20. HoosierdaddyO


    Sep 8, 2015
    Flip a coin!
    Angry Birds likes this.
  21. BlackDynamite


    Nov 27, 2015
    Just casually talk about the kid like he or she has already been diagnosed with autism.

    Sent from my iPhone using SDN mobile
  22. hamstergang

    hamstergang may or may not contain hamsters 5+ Year Member

    May 6, 2012
    I'd go so far as to say it's unethical not to say anything. A friendship between 2 adults is nothing compared to the benefits this kid could get from early intervention services if there are developmental issues (autism or otherwise). You guys can find other friends. This kid doesn't get another shot at these early years and has a whole life left to live.
  23. Birdstrike

    Birdstrike 7+ Year Member

    Dec 19, 2010
    Ok, so...spill the beans. What are the specific signs that make this kid "90% certain" to have autism?
  24. Brigade4Radiant

    Brigade4Radiant 10+ Year Member

    Dec 13, 2006
    If you really going at this from the best view point of the child then both of you will still be friends if it turns out this kid doesn't have autism. Give us a preview on how you'll bring this topic up. I would approach it by saying that all children need to be screen for autism. I mean it's not like you are accusing him of abusing his child.
  25. Old_Mil

    Old_Mil Senior Member 10+ Year Member

    Nov 19, 2004
    I wouldn't.

    I'm sure that child has a pediatrician. Let them make the necessary observations.

    In general I try and avoid meddling in the health of friends and family unless it's something really obvious like "you might want to get that large growth on your head checked out" or "you look particularly gray and sweaty after climbing a flight of stairs, maybe you should call 911."
    BAM! and Angry Birds like this.
  26. Apollyon

    Apollyon Screw the GST Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 24, 2002
    I might say that, of all people on SDN (save one d-bag that will go un-named), you are the last who could demand that another spill the beans. Or maybe it's just irony. If then, carry on!
    exi, njac, NurWollen and 4 others like this.
  27. Arcan57

    Arcan57 Junior Member 10+ Year Member

    Nov 21, 2003
    So to bring a little bit of personal experience into the mix, my son was diagnosed as autistic after initially being referred to speech therapy for not meeting his speech milestones. It was only after we moved and saw a new speech pathologist that she suggested we see our new pediatrician and ended up going down the evaluation path. I think it's a lot safer to talk to your friend about an unambiguous deficit (which if he's austistic will be present) and getting them plugged into treatment for that. Typically that will cascade into an avalanche of referrals as many kids on the spectrum will require multiple services (PT/OT, speech, play therapy, psychology, etc.). Because the spectrum varies so widely and it's the more severe end of the spectrum that forms public opinion, you're more likely to get buy-in for evaluation for speech apraxia or dystonia than for autism. Having your child labeled opens up a host of resources that are very helpful (self-funding therapy would bankrupt most non physician families) but it can also be a period of intense grieving as the life you imagined for your child gets ripped away one office visit at a time.

    It's also extremely likely that your friend knows something is wrong and is hoping that whatever it is fixes itself. While there's a chance that will happen spontaneously, it's a pretty bad chance and the younger you are at initiation of treatment the better your chances are. Even a couple of years of delay in language and social development is poorly tolerated in most social and educational environments which manifests in high rates of anxiety and depression in teens on the spectrum. Be a friend, raise your concern about something that undeniable but doesn't carry the explosiveness of autism, and be ready to offer emotional support. If you're correct, your friend is in for a really rough time whether you say something or not and is going to need all the support they can get.
  28. Angry Birds

    Angry Birds Angry Troll 5+ Year Member

    Dec 4, 2011
    I guess this is the thing I am most worried about. Am I ethically culpable if I don't say anything? I'm weighing this against the fact that he is my closest, dearest friend, and also that there is a high chance he wouldn't listen to me anyways if I told him that I think something may be wrong.
  29. BAM!

    BAM! Senior Member 10+ Year Member

    Oct 4, 2004
    Diagnosing autism is not within the spectrum of Emergency Medicine. What makes us able to make this diagnosis? Have you ever made this diagnosis before?

    If it's obvious, then they know already. Telling a friend you think their kid has a mental disability is a good way to harm the friendship.

    I personally wouldn't tell the parents. Or if you feel you need to, then tread lightly, "Hey Samantha, has Little Johnny started playing with other kids yet?" See where it goes.

    I have kids, and a lot of our friends do too. There is a HUGE range of development. Especially between kids that are played with constantly vs parked in front of the TV at daycare for 10 hours a day. Doesn't mean they have autism.

    Next time you run into peds at your department, try running it by them. See what they think.

    Another consideration: there is an argument that the label of autism can be a self-fulfilling prophecy. Parents will love their kids regardless. Though they may be treated differently and looked at differently if they think their child has autism.
    Last edited: May 21, 2016
  30. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner Moderator Physician Faculty 10+ Year Member

    Aug 2, 2006
    Treat this like you should treat every other decision. Which one lets you look at yourself in the mirror. Or flip a coin, not because it will tell you what to do, but because when it's in the air you know how you want it to land. Do that path.
    If you tell him and you're right (make sure first though) you can make a huge difference in the kids life. If you don't tell him then you aren't culpable, but you could make a difference. And you'll always wonder what if.
    smq123 and Apollyon like this.
  31. Brorthopedic

    Brorthopedic 2+ Year Member

    Oct 6, 2015
    Doctor's Lounge
    Currently studying about autism and this thread randomly popped into my head from when I first read it... Now I'm curious.

    Did the child have autism? Did you end up telling him?
  32. Angry Birds

    Angry Birds Angry Troll 5+ Year Member

    Dec 4, 2011
    I took the chicken's way out and didn't say a word.

    I've since moved states so my interaction with my friend and his family is much less now.
    Brorthopedic likes this.
  33. hello1234!


    Jul 29, 2016
    I think it depends on how sure you are. 99% sure I would say of course you should say something. If you are only 90% sure, then I would be content knowing a pediatrician evaluated the kid and there's nothing more I can do.
  34. DokterMom

    DokterMom 2+ Year Member

    Mar 1, 2013
    Reprinting this very wise advice -- As another parent who has been there, I can attest to the accuracy of what @Arcan57 experiences. This is exactly what you go through, grieving layer by layer as you acknowledge that the speech impediment "technically" qualifies as a disability, and then that the qualification isn't just "technical" at all, and then that the disability is significant, and then that the disability is long term, and then, and then...

    It's a roller coaster no one wants to be on. But the benefits of early treatment are so important --

    If there's a speech delay, that's the easiest way to get a child in for an evaluation. It could be something as simple as a temporary hearing loss that can be easily fixed with tubes or even ear wax flushing -- but the consequences of not treating that quickly could be delayed speech and language development. That can be a very effective way to inject urgency and a nudge in the right direction without calling the child's awesomeness into question.
    Goro likes this.
  35. Goro

    Goro Faculty 7+ Year Member

    Jun 10, 2010
    Somewhere west of St. Louis
    This is what friends are for. Do not keep quiet.

    DokterMom likes this.

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