In Reply: There is no doubt that many physicians
are remiss in detecting autism and are underinformed about effective interventions,
as Dr Gill suggests. He recommends that physicians, although not trained in
early education, prescribe ABA (discrete trial learning). In my view, the
physician's role is to provide early detection and to ensure, without excessive
testing, that there is no medical condition (like deafness) that requires
a specific intervention. Physicians must voice the suspicion of an autistic
spectrum disorder honestly and refer the child promptly for early intervention,
as mandated by federal law. However, prescribing an exact educational program
or number of hours of ABA, occupational, physical, or speech and language
therapies goes beyond most physicians' competence. Such decisions belong to
the multidisciplinary committees on early intervention and later to each school
district's committee on disability. Rubber stamping prescriptions for therapies
requested by parents will deprive other children who might benefit from such
interventions, as early intervention programs and school districts struggle
to meet escalating demands for services for children within the autistic spectrum.
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