Standing on the shoulders of early intervention
Dr James Best stresses the importance of early intervention, support and guidance in autism, and reflects on his life-changing journey to Africa with his son Sam, diagnosed with autism at the age of 3.
This was not merely based on a sense of adventure. This was an intervention; an attempt to improve Sam’s adaptive skills through a prolonged and intense exposure to uncertainty and unpredictability.
My wife and I made this decision based on what we knew both about the latest thinking on autism and how to reduce the impact of the inherent characteristics of the disorder, and what we knew about the development of the adolescent brain.
It is now widely accepted that intensive intervention in the early years of children with autism spectrum disorder (ASD) can improve their functional outcomes. Indeed, we embarked on such an intensive early intervention (EI) with Sam when he was a pre-schooler, and witnessed the benefits it gave him all those years ago.
Much of the more recent thinking and evidence in Early Intervention (EI) in Autism Spectrum Disorder (ASD) is to push these children in the direction of new challenges and exposure to difference, which they can often find particularly difficult and stressful. It is imperative then that this exposure be accompanied by appropriate ‘scaffolding’, that is support and guidance, so the challenges are more likely to result in a series of successes, building skills, flexibility and confidence.
As Sam approached adolescence, we reflected whether we could do more for him than the conventional approach of appropriate schooling and a supportive social environment. Adolescence, after all, shares many similarities with early childhood, with researchers increasingly aware of the increase in neuroplasticity during this period. Millions of neurones and their connections flourish while those nerves and pathways less used are pruned back, all under a wash of neuronal growth factors and hormones. Adolescence has indeed been referred to as a ‘second spring.’
So that was what led us to this undertaking with Sam. Yes, it was risky, but to not take the opportunity we saw was also a risk – that the benefit that we hoped Sam would receive would never be grasped.
The trip was to prove a success, with researchers from Griffith University , who followed the intervention, finding positive changes in his social communication skills over the six months of rough travel. While only an N=1 study, we hope that it will lead to further research in this area.
However, of course, this was all built on the work we’d done with Sam back when he was little. The gains he made in Africa were standing on the shoulders of early intervention. Recent research has indicated that such evidence-based EI is not only beneficial for these children and their families, but it is also beneficial for society and the economy at large, with the very significant costs of the intervention being fully offset after only two years following intervention, due to reductions in children's use of other services.
So, it all comes back to early intervention, and this increases the importance the role of GPs and other health professionals have in screening and identifying children with ASD as early as possible. The average age of diagnosis in Australia is around four years of age; it should be under two years. This is how we can maximise the gains obtainable through evidence-based EI.
With the rolling out of the National Disability Insurance Scheme (NDIS), which funds appropriately targeted EI, such interventions will be within the reach of many more families. Hopefully GPs can rise to this challenge and enable these families to get the assistance we know will help their young child with ASD reach their potential.
Do you feel supported in assisting your patients and their children with ASD? Do you feel more can be done? Let us know in the comments below!
To learn more about the assessment, diagnosis and management of autism in children click here
Dr James Best
Sydney-based GP. He is a GP Supervisor and in 2010 he was awarded the GP Supervisor of the Year for the RACGP. Dr Best has a passion for medical education, communication issues, and paediatrics in primary care. He has presented regularly to GPs and specialists in webinars and live presentations. He has also had articles on these and other topics regularly published in national medical and mainstream media outlets. He has a clinical specific interest in paediatric disability, particularly autism, and is editor of the Child and Young Person Health Network (CYPHN) News for the RACGP. He has also co-authored guidelines for the management of ASD in general practice for ACRRM. Dr James Best has also written Sam’s Best Shot , a memoir of his and Sam’s trip to Africa and Sam’s intervention, published by Allen & Unwin.