Is Autism a “Public Health Crisis?”. Part 4
As already discussed, autism is not a homogenous disorder, either medically or behaviorally. Autism continues to be differentially diagnosed and extensive literature exists about the challenges of, and the unique features to be considered before, giving an autism diagnosis to a child (Mandel et al., 2002; Wagner & Lockwood, 1994). In children with ASD, there typically exists great variability in cognitive, adaptive, behavioral, social, developmental, expressive, and social functioning (Heward, 2003; Szatmari et al., 1995). This variability means that while one clinician might diagnose autism, another may easily and reasonably come up with a different diagnosis. Studies over the past few years have noted that autism is now routinely diagnosed for persons who would have been otherwise diagnosed just a few years ago to include those who more correctly fall into the category of communication disorders (Bishop, et al., 2008). The diagnosis of autism remains highly debated and under the influence of multiple variables. Autism ‘prevalence’ can, in part, also be predicted based on data related to demographics and/or ethnicity (Beeger et al., 2009). Of particular note is that autism prevalence can actually fluctuate based on income and neighborhood thereby risking a disproportionate concentration of money and resources in specific communities while largely overlooking others. Children living in poverty are too often identified as either mentally retarded or emotionally disturbed by schools while children living in suburban and higher income school districts are more likely to be classified as having learning disabilities or autism (Lauritsen et al., 2005; Singer et al., 1989). Clinician training, areas of specialization, professional influences, and personal frame of reference may also directly influence diagnostic decisions and outcomes (Caplan, 1996).
The Blue Ribbon Commission on ASD further implies that the field has not agreed on a definition of ‘best practice’ for persons with ASD. This contention, however, is inaccurate. Best practice refers to outcomes generated by studies that are replicable, objective, generalizable, and refutable (Alberto & Troutman, 2006). While the etiology of autism remains a mystery, autism is not at all mysterious in that educators absolutely know how to teach even the most challenging children with autism (Simpson & Myles, 1998; Koegel & Koegel, 2006; Lerman, et al., 2004). The specific concern here is that the Blue Ribbon Commission’s report on autism makes no effort to differentiate between studies that:
Many current biomedical claims and other treatments for ASD are disseminated in ways so as to broadly deny their refutability or replicability by external and objective researchers and clinicians. One primary example from a few years ago was when the promoters of Facilitated Communication (FC) claimed objective clinicians and researchers could not initiate studies of the procedure because it would risk the ‘rapport’ with those being facilitated. In other words, FC would never be effective when studied by other objective researchers (Offit, 2008). Promoters of FC subsequently utilized testimonials, hypothetical data, and other unsubstantiated anecdotal evidence to argue for their model.2 FC was ultimately recognized as invalid for persons with ASD and has largely left autism services. Such problematic clinical practices, however, continue across a number of current biomedical and intervention models (Bodfish, 2005; Jacobson, et al.,, 1995; Offit, 2008).