Thursday, 26 January 2017

Andrew Whitehouse on challenging yet another autism status quo: diagnosis before intervention

"This paper provides an overview of the benefits and drawbacks of the current clinical pathway that places primacy on a diagnostic assessment for triggering the commencement of therapy. The paper then presents an alternative clinical pathway - the identification and provision of therapy to infants at risk of ASD [autism spectrum disorder] - and provides a critical review of current evidence supporting this model."

So said the 'lecture paper' by Andrew Whitehouse [1] and, as per the title of this short post, another peer-reviewed critical look at an autism status quo from this author (see here) who does not seem to be afraid to rock the boat (NB. see Cordelia Fine's new book for further discussion on the idea that there probably is no 'male' and female' binary brain differentiation).

Bearing in mind this was a paper based on a lecture given at a speech and language conference in Australia, I'm once again intrigued with the sentiments expressed by Prof. Whitehouse, who really does seem to be quite clued into how (a) an autism / autism spectrum diagnosis is for many children, happening 'too late' in terms of the time between when symptoms start manifesting and them getting an 'official' label, and (b) how quite a few children are entering into early intervention programs (for autism) before formal diagnosis is given (see here). I'm not going to go into the possible reasons 'why' the diagnostic pathway seems to be such a long one for so many (although there are clues outside of 'we're just better at recognising autism') but it strikes me as eminently sensible that if a child presents with autistic traits/behaviours, why wait for formal assessment but rather set plans in motion to 'zoom in' on specific areas where intervention might be required. Yes, there will be cost implications - without sounding too conspiracy-like, I've often wondered whether the 'queues' of those waiting for diagnosis at least here in Blighty is partly because the powers-that-be know that there will be cost implications following a diagnosis - but if one assumes that early intervention might have some long-term positive effects (see here) even the bean counters might see some benefits. I might add that whilst behavioural intervention is probably important, this should not be at the expense of other 'types' of intervention for some 'types' of autism (see here) and the value of other screening programs outside of just asking 'is it autism' (see here)?

'Nuff said, for now at least but I will be coming to another Whitehouse paper quite soon on this blog...


[1] Whitehouse AJ. Elizabeth Usher Memorial Lecture: Rethinking the clinical pathway for autism spectrum disorder and challenging the status quo. Int J Speech Lang Pathol. 2017 Jan 13:1-10.

---------- Whitehouse AJ (2017). Elizabeth Usher Memorial Lecture: Rethinking the clinical pathway for autism spectrum disorder and challenging the status quo. International journal of speech-language pathology, 1-10 PMID: 28084105