Cambridge 02138
Alpha girls, repressed memories, Undergraduate insights
SPECTRUM OF AUTISM OPINIONS
As the parent of a child with autism and a writer on the subject for About.com, I enjoyed reading “A Spectrum of Disorders” (by Ashley Pettus, January-February, page 27). I would like to comment on one point. The author, in describing intensive behavioral therapy for very young children, says “Although ABA [applied behavioral analysis] strikes some parents as an unnatural and excessively regimented treatment, many researchers now agree that, for the most severely affected children, it is necessary to apply the most intensive strategy at the youngest possible age....The exposure of a young child who may not be autistic to intensive behavioral, speech, and language therapies will certainly not harm the child’s development.”
ABA is generally recommended for 40 hours a week. In addition, as the article notes, most parents don’t stop with ABA. They add in a range of additional therapies, some quite intensive and carrying significant risks for the child (chelation therapy, megavitamin supplements, hyperbaric oxygen therapy, and so forth). That means that a two-year-old could be experiencing 50 to 60 hours per week of intensive therapy—leaving no time for typical interaction with peers or with the world around him. It’s hard to believe that such intervention “will not harm the child’s development,” particularly if the autism diagnosis turns out to be incorrect.
There are other options for treatment, not discussed in this article, such as “Floortime” and Relationship Development Intervention (RDI), which are far more developmentally appropriate than ABA. For a child with a “borderline” diagnosis, these offer both the intensity of ABA and far broader, more naturalistic opportunities for engagement with parents, siblings, peers, and the world. They are not as intensively studied, but research so far shows very positive outcomes.
In addition, while researchers do recommend intensive early intervention, I have yet to find any research that compares that type of intervention with later treatment. It is, of course, easier for parents and teachers to work intensively with younger, smaller children—but I can find no evidence that it’s actually more effective. The push to early-as-possible intervention leads to panic—with parents rushing to provide every possible treatment prior to an imaginary “deadline” when the “window of opportunity” will slam shut. This phenomenon creates all the problems the author notes (financial and marital stress, to name a few)—and encourages parents to seek out and implement every possible treatment, no matter how unresearched or potentially dangerous, before it’s “too late.”
With so much emphasis on early diagnosis and intensive treatment, combined with a panicked rush to the finish line, it’s easy to forget some very basic truths.
A child with autism is still a child—and despite all mythology to the contrary, is almost certainly capable of love, joy, and engagement with other human beings.
There is no “window of opportunity.” Your child can benefit from therapy throughout his or her lifespan.
It may never be possible to “fix” your child with autism—even if you start early and work hard. But the truth is that many, many people with autism can and do live creative, fulfilled lives.
Lisa Jo Rudy
Falmouth, Mass.
I was disappointed to read the article and to learn nothing new about autism spectrum disorders (ASDs). I found Pettus’s article both shallow and misleading. Pettus dismisses the possible thimerosal (ethylmercury) connection to autism, despite the fact that the latest research demonstrates a definitive link between higher levels of mercury in the blood and autism.
Pettus also misuses the term “recover” when she applies it to training such as Applied Behavioral Analysis, which is a therapy. “Recovery” is properly used to describe the process by which autistic children are healed by therapies such as chelation (removal of heavy metals from the body) and diet modifications. I was shocked not to see any mention of the gluten-free, casein-free diet that has helped many parents to recover their autistic children. For an article that claims to discuss the “biological basis of autism” to ignore basic body chemistry is unforgivable.
Finally, Pettus succumbs to rhetoric popular with Big Pharma and shallowly researched mainstream press articles when she claims that “it is not possible to get an accurate count of real cases prior to the early 1990s.” Certainly, any diagnosis of a mental disorder is at some level a judgment call, and there has likely been some mislabeling of autism. However, to imply that the increase in autism diagnoses is purely a shift in semantics is to be intentionally ignorant. ASDs did not exist at all prior to the 1930s; environmental factors (possibly combined with a genetic predisposition) are the most likely explanation for the skyrocketing diagnoses of these devastating disorders. To focus only on possible genetic causes of ASDs is to ignore a whole universe of prevention and therapy. I expected more from Harvard.
Theresa V. (Makin) O’Brien ’00
New York City
Editor’s note: Other correspondents suggested as causes for autism exposure to plastics, ear infections that compromise language development, aggressive management of childbirth and resulting fetal distress, miscellaneous toxins, other ingredients in vaccines, and use of fetal ultrasound during pregnancy.
Ashley pettus’s thoughtful cover story does an excellent job of calling attention to “the urgent search to understand the biological basis of autism,” and the importance of early intervention and treatment in providing the best possible outcome for the 1 in 166 children who suffer from autistic spectrum disorders.
We are learning more than ever about the inner workings of the brain, yet that which we do not know is still painfully evident. Pettus’s comment that “solving the puzzle of autism will require close collaboration between those in the laboratory and those on the front lines of patient care” is right on the money, and is consistent with the National Institutes of Health’s recent focus on translating scientific discoveries into practical applications.
Similarly to autism, mood disorders such as bipolar disorder and depression are biologically based brain disorders, and there is growing evidence that these neuropsychiatric disorders may be clinically and genetically linked. As is the case with autism, there has been a dramatic increase in recent years in the number of children being diagnosed with bipolar disorder and related conditions. There remains, however, much disagreement among clinicians over the appropriate criteria for diagnosing, as well as treating, mood disorders in children. What is clear is that early and accurate diagnosis and treatment, for both autism and mood disorders, are paramount if we hope to achieve the best possible outcomes and quality of life for these children.
Jocelyn Scribano, M.B.A. ’86
Board of Directors
Child and Adolescent Bipolar Foundation
New Albany, Ohio
Contents and Changes
In this issue, two faculty members (contribute essays on matters of public interest, domestic and international, during this American presidential election year. The articles offer a double dose of the magazine’s Forum: extended, analytical versions of the familiar newspaper op-ed, sharing both information and opinion with readers. Throughout the year, the magazine will present more such essays, based on our approach to faculty members with especially stimulating arguments to share, and their approach to us. We welcome suggested topics.
At various points in the pages that follow, you will also encounter a new icon (right), which made its first appearance alongside “Tinker, Tailor, Robot, Fly” in our January-February issue (page 8). It lets you know that the magazine’s website, www.harvardmagazine.com, contains multimedia content complementary to the text: in the prior issue, a video recording the first flight of a robotic fly, and this time around, using a recipe to accompany a portrait of an accomplished baker; commentary by a stage designer; and a visit with an eclectic mathematician.
Also new on the website are “Alumni Writers” and “Harvard in the News”: selected, annotated links to articles by Harvard graduates and to news stories involving the Crimson community, respectively. Both features are updated continuously, along with the staff’s “Breaking News” dispatches: on-line stories filed as news occurs, between the bimonthly appearances of your printed Harvard Magazine. In most cases, such topical accounts are reported further for the published magazine—as is the case with the December 10 and 12 on-line accounts of the College financial-aid initiative and the appointment of the new Graduate School of Arts and Sciences dean, appearing here, on pages 54 and 63, with more detail and perspective.
Finally, although his work appears as usual throughout this issue, deputy editor Craig Lambert on January 1 began a year-long leave to work on a book and other projects. In his absence, Paul Gleason has signed on as a staff writer.
~The Editors
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