Is Autism a “Public Health Crisis?”. Part 6
The issues confronting children and adults with ASD and their families are truly confounding and will continue to demand serious attention. The potential to disconnect children with ASD and their families from other children with developmental and acute learning needs and their families in schools and across the community seems illogical because many of these needs are closely interconnected. A related concern is that the Commission’s report may risk placing families of children with ASD and those who have children with other disabilities and learning needs in direct ‘competition’ for attention and resources, even though the resources and knowledge will comparably serve children in both groups. Finally, autism risks being turned into a class based disorder whereby prevalence rates, service availability, and professional resources are substantially more concentrated in higher income suburban areas than in lower income urban neighborhoods. This likelihood, alone, requires greater examination and consideration regarding the overall prevalence rates of ASD that were identified and discussed in the Commission’s report. Such prevalence by demographics (Beeger et al., 2008; Lauritsen et al., 2005; Mandel et al., 2002; Singer et al., 1989) would also appear to directly challenge a unique biomedical model for autism leading to the claims of a public health crisis.
Children with autism may be better served if autism is used as an umbrella term or disability category; autism may be considered as ‘types of autism’ rather than as having a single attributable process (Szatmari et al, 1995; Walker et al., 2004). Recent genetic studies of persons with autism have identified the likelihood that multiple sets of genes may be involved in ASD with different actions, interactions, and outcomes driven by a number of confounding variables to include ethnic history (Beeger et al., 2008; Muhle et al., 2004). Although increasingly clear evidence exists which identifies autism as a multifactoral disorder, there continues to be an inadequate understanding of the genetic and non-genetic variables involved and how they interact (Rutter, 2005). Therefore, it is not reasonable to presume either a unique biomedical model currently exists or a full range of medically necessary services for persons with autism has, or can be, identified at this time. The use of charged language to describe ASD as an ‘epidemic’ or ‘public health crisis’ distracts from the human factor while diminishing the need for environmental, individual, instructional, and quality of life change.
This change should start with an application of the resources and knowledge currently in place. The on-going ‘crisis’ mode further risks creating conditions that foster more detached and frenetic movement and treatment activity ranging from the overuse of medications and extremely expensive and unproven biomedical treatments to unnecessarily invasive instructional and intervention strategies that deny and ignore individuality and uniqueness. The continued over emphasis of the bio-medical and ‘crisis’ model in the Commission’s report and across the field of ASD risks becoming a tremendously inefficient and costly distracter, as well as a real disservice to children, their families, and communities. A renewed focus on the broader system of services, including instruction, structural supports, and collaboration for sustainable change, will better serve children with ASD and their families as well as assist other children with special needs and their families.
To assume otherwise risks wasting available and invaluable resources while nurturing a cycle in which each group will be forced to ‘reinvent a wheel’ for themselves that, in actuality, already exists.