As a speech pathologist I consider early intervention crucial, it is what speech pathologists preach, the key to progress and closing the gap is to start intervention as early as possible. However a recent journal article caught my eye, Camarata, S 2014, ‘Early identification and early intervention in autism spectrum disorders: Accurate and effective?’ International Journal of Speech Language Pathology, vol.16, no.1, pp.1-10, could this be the undoing of what I hold most dear?
The purpose of Camarata’s (Feb 2014) journal article is to address the evidence in regards to early intervention and Autism Spectrum Disorders. Although there is strong face validity that early intervention is beneficial for individuals with Autism, is the research showing the same? Camarata also raises the concern of research ‘demonstrating the effects of a particular treatment on autism symptomology’ (Camarata, S, 2014, pp.1) in comparison to the impact of this treatment as an early intervention.
Some important points and questions I feel were raised;
Most importantly he raises the question is the reason for the ‘current weak evidence in support of early intervention rooted in the diagnosis and identification of autism?’ (Camarata, S, 2014, pp.1). This comment struck a chord with me, too often I feel people have an assumption of what a child with Autism means, how that child will ‘present’, and therefore apply a certain type of intervention approach because it has worked with another child with the same diagnosis. It is here that I think intervention needs improvement; not only is each child unique and they present with their own set of strengths and challenges, but there is a need for a better understanding of that child so they are not just their diagnostic label but a full individual picture. Does the answer lie in a more rigorous diagnostic procedure?
The article raises the question in regards to the accuracy of an Autism Spectrum Disorder diagnosis over time for an individual, was it an accurate diagnosis initially? The article reports that the accuracy for a ‘classical autism’ diagnosis is 76% whereas the stability of, what was, PDD-NOS, was only 36% (Camarata, S, 2014, pp.5). Camarata (2014) also asks if this because an individual who was diagnosed with ‘classical autism’ may have demonstrated more severe autistic symptomology at an initial consult, and therefore we are more likely to have accurately diagnosed? So then the question is, the research into the effectiveness of early intervention, were the participants diagnosed correctly or were the participants perhaps largely taken from a pool of children with PDD-NOS, with low accuracy? For me as a therapist, this once again emphasises the importance to look past the label and to look at the individual strengths and challenges of the child so that your therapy approach is better suited.
The point that many studies are based off the DSM-IV diagnostic criteria, where difficulties with language are part of the triad, also was raised. The current DSM-5 criterion no longer includes language in the diagnostic criteria. Would this have impacted on the correct diagnosis of participants in many previous studies? Could these participants actually have had severe language disorders instead of an autism spectrum disorder? Camarata (2014) noted the difficulty in distinguishing between language disorders and autism in toddlers so perhaps this could change the weak evidence for early intervention in autism.
Overall, this review brought forward the current evidence in support of early intervention for autism spectrum disorders is not as strong as we may believe, however with the new DSM-5 and the new studies that will follow perhaps the results will change as we are now more accurately diagnosing? Camarata’s (2014) review of research has most definitely highlighted the need for more investigation that is fair and objective.
What I hold most dear I feel has not been taken away from me, I see daily the impact early intervention has on the many children I work with. If anything it comforts me knowing that people are constantly striving to find the best intervention and diagnostic criteria. For me I feel this article has solidified;
- accurate diagnosis and effective intervention are linked, however can often be overlooked
- clinicians need to be critical in choosing the correct therapy approach for a child
- a more rigorous form of identification, not just for ASDs but for all disabilities, needs to occur so that interventions can be specifically designed
- the need to consider a child outside of their ‘label’ and to instead look at their individual strengths and challenges
- the difficulties in evidence based research for interventions and highlighted how the progress we subjectively see every day in our clinics is difficult to prove when the initial steps (diagnosis) are not yet perfected