Brief report: an unusual manifestation of diagnostic overshadowing of pervasive developmental disorder--not otherwise specified: a five year longitudinal case study.
Severe anxiety can hide autism features—keep reassessing over time with a multidisciplinary lens.
01Research in Context
What this study did
One boy, saw doctors every year for five years. Severe separation anxiety filled his days. No one spotted the autism traits hiding underneath.
The team kept testing. They used play sessions, parent talks, and teacher forms. Year by year they peeled back the anxiety to find PDD-NOS.
What they found
At first the boy’s panic stole the show. He clung to mom and cried in class. His repetitive play and odd speech were blamed on worry.
By year five the picture flipped. Calm moments showed clear autism cues: rigid routines, flat face talk, and peer gaps. Anxiety had masked PDD-NOS the whole time.
How this fits with other research
Georgiades et al. (2011) saw the same mix in the preschoolers. They say emotional problems are core to ASD, not extra. The single case here proves the blend can hide diagnosis even at .
Nijs et al. (2016) link anxiety to insistence on sameness in the kids. Their numbers back the boy’s story: when anxiety drops, autism rituals stand out.
Kiep et al. (2017) show girls hide ASD by weaving into groups. This boy hid behind tears instead. Both papers warn: masking comes in many costumes.
Why it matters
Don’t lock the file after one label. Re-test each year, especially when anxiety is loud. Use play, parent, and teacher data together. What looks like “just anxiety” today may reveal autism tomorrow.
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02At a glance
03Original abstract
Children with communication disorders present with a range of comorbid conditions. Occasionally one of the comorbid conditions manifests so strongly that the primary condition goes unnoticed by the clinician. This tendency to overlook comorbid health problems in the presence of a disability is referred to as diagnostic overshadowing. This is a five-year follow up case study of a 9-year-old female child. The child was initially diagnosed to have Separation anxiety disorder (SAD), but during the course of follow up she began to exhibit features of pervasive developmental disorder-not otherwise specified (PDD-NOS). This case report throws light on the severity of SAD which overshadowed PDD-NOS. Importance of follow-up and the need for a multidisciplinary team to be sensitive to the phenomenon of diagnostic overshadowing is discussed.
Journal of autism and developmental disorders, 2013 · doi:10.1007/s10803-012-1691-9