Autism – Biomedical Intervention

I had heard that biomedical intervention was an approach to the treatment of autism. I also had an impression that this topic is controversial. Since I am a biomedical engineer by training and a biological determinist by inclination, I decided to discover what this the buzz surrounding biomedical intervention is all about. Due to the complexity of autism and the wealth of information about biomedical treatment options to sift through, I will have to devote more than one post to this topic to afford it proper consideration.

I’ll start with my consultation with The Oracle (Google). This is what I found:

Definition of biomedical intervention

According to the Autism Society, “Biomedical interventions are those that attempt to focus on the physical needs of the person as a biomedical organism, addressing deficits or encouraging weaker pathways by medical or chemical means.” [1] That sounds pretty simple. We are ‘biomedical organisms’, aren’t we? We are tremendously complicated biological organisms in fact.

Definition of autism

So, we have a very good definition of biomedical intervention. It would seem proper to develop a similarly good definition of autism. After all, we can’t very well intervene effectively if we don’t know the properties of the entity about which we are concerned. This is where the problems begin. The term ‘autism’ was originally used to describe a certain set of behaviors as early as 1911 (Eugen Bleuler). [2] ‘Autism’ comes from the Greek ‘autos’, which means ‘self’. Autistic behaviors were documented in medical literature in 1747, 1798 and 1809. [3] Leo Kanner (1943) [4] and Hans Asperger (1944) [5] described similar behavioral profiles in a population of their young patients, characterizing them specifically as ‘autistic’. Kanner described an ‘autistic aloneness’ and Asperger noted a “disturbance [that] results in considerable and very typical difficulty of social integration.” [6]

How is autism diagnosed?

Autism is diagnosed on the basis of behavior. There is a wide range of behaviors, and severity of disability that can be characterized as autistic. In fact, the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV (TR)) defines autism as ‘Autism Spectrum Disorder’ (ASD). They use the word ‘spectrum’ to describe to the fact that this disorder encompasses a range of behaviors. These criteria are spelled out on the Center for Disease Control (CDC) website.

Testing for autism?

There are no objective tests, such as a blood test or MRI that can detect autism. The CDC notes that diagnosing autism is a two-step process, involving: 1) Developmental screening “to tell if children are learning basic skills when they should, or if they might have delays. During developmental screening the doctor might ask the parent some questions or talk and play with the child during an exam to see how she learns, speaks, behaves, and moves. A delay in any of these areas could be a sign of a problem.” [7] According to the CDC, if the doctor notes any problems, step 2)  Comprehensive evaluation is next: “This [is a] thorough review [that] may include looking at the child’s behavior and development and interviewing the parents. It may also include a hearing and vision screening, genetic testing, neurological testing, and other medical testing.” [8]

Autism may have many different causes. According to the Mayo Clinic, “Autism has no single, known cause. Given the complexity of the disease, and the fact that symptoms and severity vary, there are probably many causes. Both genetics and environment may play a role.” [9]

One can imagine the difficulties in teasing out particular problems in a child that has a disorder that manifests only in a range of stereotypical behavior, but could have widely different causes.

Why have I been so long winded?

I thought it necessary to take the time to emphasize the complexity of autism. The fact that autism is so heterogeneous, caused by no single entity and evidenced by no single pattern of behaviors, makes it difficult to imagine that a single course of action could be effective.

Trusting the screening instruments

One of my first thoughts, while seeking information about biomedical intervention, was, “How can the observations by the doctors, or even the parents be trusted totally?” Not everyone has good observational skills; a child cannot be watched all the time; certain environmental factors may go unnoticed, such as room lighting and ambient sounds: dogs barking or subtle, normally undetectable sounds.

The CDC addresses this issue in a ‘Frequently Asked Questions’ (FAQ) section of their blog. They characterize the concerns about the validity of input from parents as:

“Myth 4: Tools that incorporate information from the parents are not valid,” [10] and reassure us with the:

“Fact: Parents’ concerns are generally valid and are predictive of developmental delays. Research has shown that parental concerns detect 70% to 80% of children with disabilities.” [11]

The CDC provides two references for this claim. [12] [13]

Somehow, I am not all that reassured with a testing instrument that misses 20% to 30% of the children with a disability. It seems to me that there should be a way to attain a more accurate determination of who has autism.

Biomedical interventions

I don’t want to end this post without at least mentioning the scope and focus of biomedical interventions for autism. Marci Wheeler, MSW of Indiana University, gives quite a good synopsis of biomedical interventions. She states that “gastrointestinal abnormalities, immune dysfunctions, detoxification abnormalities, and/or nutritional deficiencies or imbalances” [14] may be triggers for ASD and are the focus of many biomedical interventions.

In future posts, I will look into specific biomedical interventions and recommendations of some of the practitioners.

[2] Frith, U. Autism, Explaining the Enigma, Blackwell (1992) p7

[3] Wolff, S. ‘The history of autism’, Eur Child Adolesc Psychiatry 13:201-208 (2004) p202

[4] Kanner, L. ‘Autistic disturbances of affective contact’, Nervous Child, 2 pp. 217-50

[5] Asperger, H. ‘Die autistischen Psychopathen im Kindersalter’, Archiv für Psychiatrie und Nervenkrankheiten, 117 (1944), pp. 76-137

[6] Frith, U. Autism, Explaining the Enigma, Blackwell (1992) p9

[8] Ibid

[11] Ibid

[12] Glascoe FP. Evidence-based approach to developmental and behavioral surveillance using parents’ concerns. Child: Care, Health, and Development2000;26:137-149.

[13] Squires J, Nickel RE, Eisert D. Early detection of developmental problems: strategies for monitoring young children in the practice setting. Journal of Developmental and Behavioral Pediatrics 1996;17:420-427.

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