James Cusack’s piece on the results of our new autism therapy trial (A new therapy for children who may have autism risks carrying a hidden cost, 22 September) points out some paradoxes of progress, and the need for ongoing conversation.
This therapy works with parents (not the infant at all) to help their awareness and responsiveness to infant differences in communication, restoring a “synchrony” in their reciprocal interaction – the theory being that positive developmental outcomes will naturally flow. And this indeed is what we find happens. Contrary to any sense of “opposing” autism, it cherishes neurodiversity by attending to and understanding it, giving equal opportunity to these infants for an adapted and responsive social environment. The positive developmental outcomes we see are simply a consequence of getting this early communication right; the infant is able to benefit like any child from an adapted social environment. The children continued to be neurodivergent with developmental difficulties but these were more likely to be reduced below a clinical autism threshold.
The paradox is that this progress and developmental benefit might feel like a problem. First, families may no longer receive services for which an autism diagnosis is an entry ticket. This just highlights the perverse incentives in resource allocation, and the focus should surely be on a better system based on needs. We highly appreciate, too, concerns around autistic identity, but neurodiversity and the essential need for good adaptations to it remain. Maybe what really needs to happen as a result of this work is an examination of the very concept of clinical diagnosis itself and the way it is made.
Prof Jonathan Green University of Manchester and Prof Andrew Whitehouse University of Western Australia
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