Child Neurologists as Evaluators of Developmental Disorders

Child neurologists are required to evaluate and care for an increasing number of children with developmental disorders; therefore they need to be familiar with the more prevalent ones, in particular the autism spectrum disorders which may masquerade as others. Their assessment needs to include a screening mental status evaluation and reviewing a recent definitive test of hearing in all children with defective speech. Neurologists’ responsibility is to make sure that there is no likely underlying problem like epilepsy, neurologic, or genetic condition that requires specific medical intervention or genetic counseling. They need to discuss with the parents how deeply to test for neurologic, neuropsychologic, or genetic underlying causes in children with “idiopathic” developmental problem. There is no routine work-up, thus neurologists need to be aware of and to protect children from many almost certainly uninformative, expensive tests like EEGs, brain imaging, metabolic tests, and genetic micro-array unless there is a specific indication, or testing is being performed with parents’ consent for research and paid for by research, not clinical, funds. Child neurologists-in-training need to have observed psychologic/neuropsychologic testing so that they have at least a superficial understanding of the content, indications, and limitations of major tests. I do not recommend that child neurologists administer standardized tests or questionnaires, but they need to know enough about them to be able to judge their appropriateness and review recommendations with parents. Neurologists need to protect children from unnecessary testing, ineffective and in some cases potentially dangerous exploitative treatments. They must be aware of what legitimate therapies are likely to be offered, that early appropriate education is most effective long-term because it influences brain development and is superior to symptomatic pharmacotherapy. If pills are needed, child psychiatrists are likely to be better informed than neurologists and need to be consulted whenever medications familiar to neurologists are not adequately effective.