#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.

1. Prioritize Whole-Child Personalized Care

Focus on understanding the unique profile of each child, including their strengths and challenges, rather than just their diagnostic label, to create effective and personalized treatment plans.

2. Understand Behavior’s Underlying ‘Why’

When observing oppositional or challenging behaviors in children, seek to understand the underlying reasons (e.g., anxiety, impulsivity, social difficulties, sensory overload) as this ‘why’ is crucial for developing effective interventions, rather than simply labeling the behavior.

3. Assess Impairment for Diagnosis

When considering a diagnosis for anxiety, ADHD, or autism, focus on whether the child’s traits are creating significant impairment in their function, such as their ability to learn, make friends, or contribute positively in school and community settings.

4. Engage in Behavioral Parent Training

Participate in behavioral parent training, especially for ADHD in children under six, as parents can be incredibly powerful in modifying a child’s behavior and helping them develop new skills and habits.

5. Seek Integrated Multidisciplinary Teams

Look for healthcare providers and clinics that offer an integrated, multidisciplinary team approach, including collaboration with teachers and therapists, to ensure all professionals are working from the same understanding of the child’s needs.

6. Select Flexible, Collaborative Providers

When choosing a provider, ensure they embrace a ‘one size does not fit all’ philosophy, are proactive in arranging collaboration meetings with other professionals (e.g., speech therapists, teachers), and have strong skills in parent training.

7. Utilize Applied Behavioral Analysis (ABA)

Consider ABA as a behavioral intervention, particularly for children with autism, focusing on naturalistic forms like Pivotal Response Treatment (PRT) that train parents to apply skills in the child’s everyday environment with natural motivators.

8. Evaluate ABA Therapist Quality

When selecting an ABA therapist, prioritize those who are well-trained, well-supervised, and demonstrate a nuanced understanding of autism and the individual child’s profile, rather than just following a generic ‘recipe’.

9. Consider Medication for ADHD (Ages 6+)

For children aged six and older with ADHD, consider medication (stimulants or non-stimulants) alongside behavioral parent training, as research shows it can significantly help with focus, impulse control, and overall success, with many parents wishing they started sooner.

10. Manage ADHD Medication Side Effects

If a child experiences side effects from ADHD medication (e.g., decreased appetite, sleep issues, feeling less social), communicate with the doctor to adjust the dose, timing, or switch to a different medication or brand to optimize benefits and minimize negatives.

11. Leverage Medication for Skill Practice

Understand that ADHD medication can make it easier for children to practice and develop new skills, such as attention and impulse control, which in turn strengthens neural networks and can lead to lasting behavioral changes through neuroplasticity.

12. Use Non-Stimulants for Emotional Regulation

For children with ADHD, especially those with emotional dysregulation or impulsive emotions, consider non-stimulant medications (e.g., Strattera, guanfacine, clonidine), which can be used alone or in combination with stimulants.

13. Medicate Autism Symptoms, Not Core Condition

For children with autism, medication does not treat the core symptoms but can be used to address specific target behaviors and associated symptoms like hyperactivity, impulsivity, emotional dysregulation, anxiety, rigidity, or aggression.

14. Bridge Healthcare and Education Systems

Advocate for and seek collaboration between healthcare providers and educational institutions (e.g., school observations, IEP meetings) to create a holistic and integrated approach that supports a child’s development and well-being.

15. Recognize Neurodiversity, Avoid Labels

Be flexible in thinking about diagnoses, understanding that definitions change and that ’neurodiversity’ means everyone is different; focus on understanding the individual person rather than getting fixated on a label.

16. Consider Adult Assessment for Validation

If you are an adult who recognizes your own childhood traits in your child’s diagnosis, consider seeking an assessment for yourself, as this information can be empowering for self-understanding and improving relationships and work performance.

17. Start Early with Autism Diagnosis

If concerns arise, seek an autism diagnosis as early as 18 months (though typically 3-4 years), as early intervention can significantly impact a child’s development.

18. Start Early with ADHD Diagnosis

For ADHD, while diagnosis is technically possible at four years, consider waiting closer to school age (five to six) to observe how the child evolves before making a definitive diagnosis, though behavioral interventions can start earlier.

19. Start Early with Anxiety Diagnosis

Be aware that anxiety conditions, such as separation anxiety or selective mutism, can be diagnosed in preschoolers, and early intervention can help when it impacts a child’s ability to function.

20. Use Third-Person for Child Self-Esteem

When assessing self-esteem in primary elementary school-aged children, use third-person scenarios (e.g., ‘Why might another child feel uncomfortable?’) to help them relate and articulate their own feelings and experiences.