Dear Mr. Preidt,
First, we would like to thank you for highlighting the importance of early detection and intervention for autism spectrum disorders (ASD) in your HealthDay article, “Timing of Autism Diagnosis Tied to Choice of Treatment.” Timing of diagnosis may be one of the most important yet overlooked topics concerning the assessment and treatment of ASD. As you correctly point out there are very effective behaviorally- based treatments, such as applied behavior analysis (ABA), available for ameliorating the core symptoms of ASD. However, without accurate and timely detection by frontline providers such as pediatricians, the full benefits of these evidence-based behavioral therapies will not be available to many families.
As you say, other treatments including antidepressants, stimulants, and complementary and alternative therapies such as nutritional supplements are “not as strongly supported by research.” However in addition to being controversial, many alternative treatments have no empirical support whatsoever. Some do have empirical evidence showing ineffectiveness and some have even been shown to be harmful. Although at first glance many of these alternative therapies, such as dietary supplements, may seem “worth a try” there are other factors to consider. Families have limited resources in terms of time and finances. Allocating these valuable resources for unsupported or ineffective treatments takes resources away from evidence-based therapies. Even more importantly, this may further delay access to evidence-based behavioral therapies. Therefore it is important to explore why those families who receive a later diagnosis are more likely use alternative therapies.
The primary conclusion you come to is that earlier detection may lead to earlier intervention using behavior therapies and better outcomes for children with autism. This conclusion suggests the importance of exploring other questions, such as how can we refine screening and detection practices, how can we provide more effective education for frontline providers, how can we overcome differential access to quality providers with the appropriate expertise in assessment, and how can we help families obtain access to qualified treatment providers?
Finally, it should be noted that the term “behavior therapy” encompasses many different approaches to psychological and behavioral disorders. It should be clarified that the form of behavior therapy with the greatest base of empirical support for addressing the core symptoms of ASD is applied behavior analysis (ABA). Other “behavioral therapies” such as cognitive behavioral therapy, which has shown to be effective for many other psychological disorders, is not as effective as ABA for the core symptoms of ASD.
Thank you again for exploring such an important topic.
Sincerely,
Justin DiScalfani, Ph.D., BCBA-D and Peggy Halliday, M.Ed., BCBA
Association for Science in Autism Treatment
