Should Kids with ABI Receive an Autism Diagnosis?
Unfortunately, acquired brain injury (ABI) is a common cause of mortality and morbidity in young children. Various illnesses and injuries, including head trauma, stroke, seizure, infection, and cardiac arrest, can cause ABIs. ABI, from a primary neurologic diagnosis, accounts for approximately 20% of all pediatric intensive care unit (PICU) admissions and more than 60,000 hospital admissions annually. ABI can also be caused from unrelated to PICU admissions, such as delirium, neuroactive medication exposure, and prolonged immobilization, which are often linked to several medical, cognitive, behavioral, and academic outcomes for pediatric patients. A new review using studies published from January 2009 to August 2022 on PubMed and Scopus databases has examined social and behavioral changes that occur in children who have experienced ABI and compared those characteristics to social and behavioral issues that children with autism spectrum disorder (ASD) exhibit. The review’s main finding showed that a subset of children with ABI display decreased social participation, poor social adjustment, and social cognitive deficits (including impairment of Theory of Mind). The review also discovered that these deficits sometimes occur without cognitive or behavioral problems. The authors suggest that mild ABI presentations need to be monitored so that support can be administered for social functioning, if appropriate. In addition, the authors pointed out that given the occurrence of social changes following ABI and neuroimaging studies documenting neurophysiological differences in key social brain network regions, the similarities in behavioral profiles of some children with ABI and those of children with autism make sense. The review also addressed whether or not providing an ASD diagnosis for the subset of children with ABI that show social and behavioral issues is appropriate. The authors said they found studies that argue that ABI is so dissimilar to ASD, especially for children who experience ABI in late childhood or adolescence, that the conditions should not be considered under the same label. Conversely, other studies suggest that ASD is a behaviorally defined disorder; therefore a diagnosis should not depend on whether the etiology was due to injury, genetic abnormality, or idiopathic occurrence. The authors conclude that, like ASD, ABI is characterized by significant neuropsychological and medical heterogeneity. Changes in social, behavioral, cognitive, adaptive, and emotional functioning are different for individuals with ABI. Due to this variability, individualized and tailored assessment, monitoring, and intervention should be required to ensure children and adolescents with ABI and their families are supported from initial injury through long-term recovery.
