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Letters |

Interventions for Autism—Reply

Isabelle Rapin, MD
JAMA. 2001;286(6):670-671. doi:10.1001/jama.286.6.670.
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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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