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Guest foreword
Diagnosis and Treatment of Autism Spectrum Disorders Patricia Manning-Courtney, MD, Jennifer Brown, PhD, Cynthia A. Molloy, MD, MS, Judy Reinhold, RN, MSN, CPNP, Donna Murray, PhD, Rena Sorensen-Burnworth, PhD, Teri Messerschmidt, MA, CCC/SLP, and Bridget Kent, MA, CCC/SLP
Dr Solomon is a nationally recognized expert in childhood autism. The editors are delighted that he agreed to write the following guest foreword. John M. Pascoe, MD, MPH, Associate Editor
Guest Foreword In the late 1980’s and early 1990’s, textbooks questioned the positive impact of therapeutic interventions for autistic children. In the past decade, there has been a virtual revolution in the way we can help children with autistic spectrum disorders (ASD). Beginning with the Individuals with Disabilities Education Act (IDEA) and the creation of nationwide special education schools in the 70’s, to the special education preschools of the 80’s, to the early intervention birth to 3 programs of the 90’s, America has become a world leader in helping children with disabilities achieve their potential. The services of special education programs are now immediately available to all children, their families, and their pediatricians in practically every school district in every state. Though critical as a first step, special education programming alone is not enough for many children with autism.
Curr Probl Pediatr Adolesc Health Care, October 2003
Children with autism have a neurologic and neuropsychologic condition, largely genetic in origin, that stunts their abilities to grasp the complexity of the social world. They live in a narrow neurologic comfort zone, with the overriding goal to keep the world the same. In short, they shut themselves down to feel in control and may not benefit from school-based programs. Ironically, many of these children are very intelligent and have the latent capacity to gain excellent language and social skills if only we would identify them early— between the ages of 18 months and 3 years—and begin intensive intervention. As this monograph by Manning-Courtney and her colleagues reports, the work of Eric Schopler1 and his TEACCH program clearly showed that therapeutic intervention DOES have a beneficial effect. Subsequently, McEachin and associates2 demonstrated dramatic gains in half of children
281
treated intensively— one-on-one for 40 hours per week— using behavioral approaches. The National Research Council recommends 25 hours per week, one-on-one to start, using an intervention that is engaging and has a strategic (language skills, social skills) direction.3 These interventions often change the course of a child’s entire life. To make the matter more urgent, ASDs are increasing in prevalence. There appears to be an absolute increase above and beyond earlier identification or finding milder cases. One in every 175 children has autism, making it much more common than Down Syndrome or childhood cancer.4 The average pediatrician encounters many of these young children each year in his or her practice. Fortunately, there are a number of ways to identify children at a very young age and, once recognized, there are clear guidelines on the medical evaluation and pharmacologic approaches as well as educational/behavioral interventions. Please read this monograph, “The Diagnosis and Treatment of Autism Spectrum Disorders,” immediately. It is timely, well-researched, comprehensive, and well-organized. Most important,
282
it is practical. The authors discourage a “wait and see” approach, and encourage pediatricians to become knowledgeable about early intervention programs in their locale.
Richard Solomon, MD Clinical Associate Professor Section Chief Department of Behavioral Pediatrics University of Michigan Department of Pediatrics and Communicable Diseases References 1. Panerai S, Ferrante L, Zingale M. Benefits of the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) programme as compared with a non-specific approach. J Intellect Disabil Res 2002;46:318-27. 2. McEachin JJ, Smith T, Lovaas OI. Long term outcome for children with autism who received early intensive behavioral treatment. Am J Ment Retard 1993;97:359-72. 3. Lord C, Bristol-Power M, Cafiero J, et al. Educating children with autism. Washington, DC: National Academy Press; 2001. 4. Bertrand J, Mars A, Boyle C, et al. Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics 2001;108:1155-61.
Curr Probl Pediatr Adolesc Health Care, October 2003
Dr Solomon is a nationally recognized expert in childhood autism. The editors are delighted that he agreed to write the following guest foreword. John M. Pascoe, MD, MPH, Associate Editor
Guest Foreword In the late 1980’s and early 1990’s, textbooks questioned the positive impact of therapeutic interventions for autistic children. In the past decade, there has been a virtual revolution in the way we can help children with autistic spectrum disorders (ASD). Beginning with the Individuals with Disabilities Education Act (IDEA) and the creation of nationwide special education schools in the 70’s, to the special education preschools of the 80’s, to the early intervention birth to 3 programs of the 90’s, America has become a world leader in helping children with disabilities achieve their potential. The services of special education programs are now immediately available to all children, their families, and their pediatricians in practically every school district in every state. Though critical as a first step, special education programming alone is not enough for many children with autism.
Curr Probl Pediatr Adolesc Health Care, October 2003
Children with autism have a neurologic and neuropsychologic condition, largely genetic in origin, that stunts their abilities to grasp the complexity of the social world. They live in a narrow neurologic comfort zone, with the overriding goal to keep the world the same. In short, they shut themselves down to feel in control and may not benefit from school-based programs. Ironically, many of these children are very intelligent and have the latent capacity to gain excellent language and social skills if only we would identify them early— between the ages of 18 months and 3 years—and begin intensive intervention. As this monograph by Manning-Courtney and her colleagues reports, the work of Eric Schopler1 and his TEACCH program clearly showed that therapeutic intervention DOES have a beneficial effect. Subsequently, McEachin and associates2 demonstrated dramatic gains in half of children
281
treated intensively— one-on-one for 40 hours per week— using behavioral approaches. The National Research Council recommends 25 hours per week, one-on-one to start, using an intervention that is engaging and has a strategic (language skills, social skills) direction.3 These interventions often change the course of a child’s entire life. To make the matter more urgent, ASDs are increasing in prevalence. There appears to be an absolute increase above and beyond earlier identification or finding milder cases. One in every 175 children has autism, making it much more common than Down Syndrome or childhood cancer.4 The average pediatrician encounters many of these young children each year in his or her practice. Fortunately, there are a number of ways to identify children at a very young age and, once recognized, there are clear guidelines on the medical evaluation and pharmacologic approaches as well as educational/behavioral interventions. Please read this monograph, “The Diagnosis and Treatment of Autism Spectrum Disorders,” immediately. It is timely, well-researched, comprehensive, and well-organized. Most important,
282
it is practical. The authors discourage a “wait and see” approach, and encourage pediatricians to become knowledgeable about early intervention programs in their locale.
Richard Solomon, MD Clinical Associate Professor Section Chief Department of Behavioral Pediatrics University of Michigan Department of Pediatrics and Communicable Diseases References 1. Panerai S, Ferrante L, Zingale M. Benefits of the Treatment and Education of Autistic and Communication Handicapped Children (TEACCH) programme as compared with a non-specific approach. J Intellect Disabil Res 2002;46:318-27. 2. McEachin JJ, Smith T, Lovaas OI. Long term outcome for children with autism who received early intensive behavioral treatment. Am J Ment Retard 1993;97:359-72. 3. Lord C, Bristol-Power M, Cafiero J, et al. Educating children with autism. Washington, DC: National Academy Press; 2001. 4. Bertrand J, Mars A, Boyle C, et al. Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics 2001;108:1155-61.
Curr Probl Pediatr Adolesc Health Care, October 2003