To the Editor: In the Clinical Crossroads article
about a boy with autism, Dr Rapin1 fails
to promote an appropriate national standard for early diagnosis and treatment.
Families that have children with autism are faced with a wide variety of proposed
treatments, many with anecdotal claims of efficacy of which almost none are
supported by objective evidence. Rapin implies that all modern intervention
programs are equivalent, but this is not supported by the literature. Rapin
advises that "the choice and intensity of educational approaches is an educational,
not medical, decision." Unfortunately, inadequate understanding of autism
and current trends toward the less specific diagnosis of developmental delay
have led to the current norm of low-intensity, nonspecific early intervention.
This policy is disastrous for children with autism. It wastes the opportunity
for intensive early intervention, which multiple lines of evidence support
as the best time to substantially alter the dismal natural history of autism.2 Physicians must be knowledgable about and advocate
for effective, specific early intervention.
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