Is Autism a “Public Health Crisis?”. Part 2
From the outset, the report routinely refers to ASD as a medical ‘epidemic’ and a ‘public health crisis’ and argues for the need to create an “Office of ASD” under the auspices of the Department of Public Health. This recommendation is troubling and leads this author to wonder why California is not considering an Office of Down Syndrome, Attention Deficit Hyperactivity Disorder, Conduct Disorders, or Learning Disabilities because these are also highly prevalent categories of disability with deserving and similarly needy children and families.
Parents of children in any of these categories could persuasively argue they and their child lack explicit and specialized services. An Office of ASD risks generating resentment, antipathy and competition across communities of families, providers, and professionals as it appears to place one category of need up against another. Referencing a ‘public health crisis,’ Chapter 3 of the Commission’s report begins with policy recommendations stating health plans should “provide a full range of medically necessary services…for ASD” (2007, p. 30).
The chapter, however, never actually offers guidance or detail towards which “medically necessary services” are consistently and uniquely required for persons with ASD. As a result, the matter continues to dangle precipitously allowing conjecture, contention, and emotion to drive the discussion. Furthermore, whether persons with ASD have agreed upon medical needs or consistently required medical treatments remains a highly controversial and disputed service model (Johnson & Myers, 2007; Offit, 2008). The recommendation for health plans to provide ‘medically necessary services’ to those with ASD is premature due to the dramatic heterogeneity typically seen in persons with ASD and since studies intended to establish a broader understanding of the medical profiles present in ASD are on-going and continue inconclusive (Rutter, 2005; Szatmari et al., 1995). The risk increases as parents and others become increasingly driven to try unproven, expensive, often time intensive and inconsistently productive medical interventions with their children with ASD. The Commission’s report risks further clouding the importance of research validated behavioral, instructional and related interventions rather than offering helpful thoughts or shedding any real light upon the issue. The Commission should have offered a clear definition of research validated intervention practices as it relates to treatment efficacy, viability, safety and applicability. For this reason, health plans can hardly be mandated to “provide a full range of medically necessary services” for persons with autism because that ‘range’ has neither been identified nor agreed upon between medical and related clinical professionals (Baird et al., 2003; Offit, 2008; Wagner & Lockwood, 1994). Biomedical and related interventions cannot yet berecommended based on a diagnosis of autism alone in the same way that insulin is ordered for Type I Diabetes or bronchodilators are prescribed to those with asthma. Too often, specific medical recommendations are categorically offered for those diagnosed as having ASD, and it is disappointing that the Commission’s report referenced “…medically necessary services” (p. 30) without question or discussion.
In fact, there is a growing body of literature that not only questions the efficacy of particular biomedical treatments but has identified specific risks to children who undergo some of these treatments. These treatments can range from chelation and nutrition, to mega doses of vitamins, and injections of Lupron (Levy et al., 2007; Offit, 2008, Seidel, 2006).