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August 8, 2001

Interventions for Autism

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

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

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.