Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. 290 (doi:10.1542/peds.2005-0742)

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kliewer, C. Articles by Schneiderman, H. Search for Related Content PubMed PubMed Citation Articles by Kliewer, C. Articles by Schneiderman, H. Related Collections Neurology & Psychiatry Social Bookmarking                         What's this?

Response to "Scientifically Unsupported and Supported Interventions for Childhood Psychopathology: A Summary"

Chris Kliewer, PhD
Department of Special Education,
University of Northern Iowa,
Cedar Falls, IA 50614-0601,

Alicia Broderick, PhD
Celia Oyler, PhD
Curriculum and Teaching,
Teachers College, Columbia University,
New York, NY 10027

Donald N. Cardinal, PhD
School of Education,
Chapman University,
Orange, CA 92866

Paula Kluth, PhD
Autism Consultation,
Chicago, IL 60630

John B. Moeschler, MD
Department of Pediatrics,
Dartmouth Medical School,
Division of Genetics and Child Development,
Dartmouth Hitchcock Medical Center,
Lebanon, NH 03756

Herbert Schneiderman, MD, FAAP
Department of Pediatrics,
Upstate Medical University,
Syracuse, NY 13210

To the Editor.

The inclusion in Pediatrics of psychologist Scott Lilienfeld's article "Scientifically Unsupported and Supported Interventions for Childhood Psychopathology: A Summary"1 did an extreme disservice to your readers and those whom they treat. Although nearly the entire article could be challenged as a poorly written opinion piece rather than a critical review of the literature, we were most concerned with the section devoted to Lilienfeld's interpretation of autism. His characterization of the disability as both a psychopathology and a psychiatric disorder demonstrates what may best be termed a 1950s view of autism.

We have come a long way from that era when "refrigerator mothers" were blamed for their children's autism. Facilitated communication (FC), summarily dismissed in 1 paragraph by Lilienfeld, is an approach that has profoundly influenced emergent views of the nature of autism. Certainly the ethical controversies surrounding FC should not be ignored, but presenting only 1 view as if it reflected an unchallenged truth is antithetical to the spirit of rigorous, open, scientific inquiry. Lilienfeld failed to describe the process by which certain research articles were included and others excluded in his review. He did not report several key citations that contradict his opinion.

Lilienfeld contends that "FC is premised on the notion that autistic children suffer [sic] not from an intellectual and affective impairment but from an exclusively motor impairment termed developmental apraxia, which impedes their ability to speak properly"1^(p762) and offers a citation for this pronouncement.2 We are unaware of any work, including that cited, that describes autism as exclusively developmental apraxia. Rather, those who are researching FC take into consideration movement disturbances in individuals labeled autistic as one of a complex array of factors involved in the spectrum of autism. In the 15 years since FC has been widely analyzed and evaluated, motor praxis and its relation to autism have shifted from peripheral interest to one of several central foci in studies of the developmental disorder.3–6 Lilienfeld has either ignored or disregarded these citations and the contemporary view of autism.

Lilienfeld opines that controlled studies "overwhelmingly" demonstrate that FC is ineffective. This is simply not true. A number of peer-reviewed, controlled studies have validated the communication of individuals with autism who are communicating with facilitated support.7–15 Additionally, Mirenda16 recently documented that "[t]oday there is a growing number of individuals in North America and elsewhere who once relied on facilitation (ie, physical support at the hand or arm and emotional support) to type but are now independent typists (e.g., Blackman, 1999)[17] or even functional speakers (e.g., Broderick & Kasa-Hendrickson, 2001).[18]" Her point is that for this group the controversy over their communication has necessarily ended. Included among her sample is Sue Rubin, a young woman with autism who wrote a 2005 Academy Award–nominated documentary depicting her life experience.19

Lilienfeld's failure to acknowledge compelling evidence of FC's effectiveness in the lives of particular people with autism reflects not science or a scientific vantage point but bias, prejudice, a lack of investigative rigor, and an outdated understanding of developmental disability. Pediatrics should not promote this type of opinion as if it were fact.

REFERENCES

1. Lilienfeld SO. Scientifically unsupported and supported interventions for childhood psychopathology: a summary. Pediatrics.2005; 115; 761 –764[Abstract/Free Full Text]
2. Biklen D. Communication unbound: autism and praxis. Harv Educ Rev.1990; 60 :291 –314
3. Teitelbaum O, Benton T, Shah PK, Prince A, Kelly JL, Teitelbaum P. Eshkol-Wachman movement notation in diagnosis: the early detection of Asperger's syndrome. Proc Natl Acad Sci USA.2004; 101 :11909 –11914[Abstract/Free Full Text]
4. Teitelbaum P, Teitelbaum O, Nye J, Fryman J, Maurer RG. Movement analysis in infancy may be useful for early diagnosis of autism. Proc Natl Acad Sci USA.1998; 95 :13982 –13987[Abstract/Free Full Text]
5. Donnellan AD, Leary MR. Movement Differences and Diversity in Autism. Madison, WI; DRI Press:1995
6. Leary MR, Hill DA. Moving on: autism and movement disturbances. Ment Retard.1996; 34 :39 –55[Web of Science][Medline]
7. Calculator SN, Singer KM. Preliminary validation of facilitated communication [letter]. Top Lang Disord.1992; 12 (4):ix–xvi
8. Cardinal D, Hanson D, Wakeham J. Investigation of authorship in facilitated communication. Ment Retard.1996; 34 :231 –242[Web of Science][Medline]
9. Emerson A, Grayson A, Griffiths A. Can't or won't? Evidence relating to authorship in facilitated communication. Int J Lang Commun Disord.2001; 36 (supp):98–103
10. Janzen-Wilde M, Duchan J, Higginbotham D. Successful use of facilitated communication with an oral child. J Speech Hear Res.1995; 38 :658 –676[Medline]
11. Niemi J, Karna-Lin E. Grammar and lexicon in facilitated communication: a linguistic authorship analysis of a Finnish case. Ment Retard.2002; 40 :347 –357[Medline]
12. Sheehan C, Matuozzi R. Investigation of the validity of facilitated communication through the disclosure of unknown information. Ment Retard.1996; 34 :94 –107[Web of Science][Medline]
13. Tuzzi A, Cemin M, Castagna M. "Moved deeply I am": autistic language in texts produced with FC. J Int Anal Stat Donnees Textuelleds.2004; 7 :1 –9
14. Weiss M, Wagner S, Bauman M. A validated case study of facilitated communication. Ment Retard.1996; 34 :220 –230[Medline]
15. Zanobini M, Scopesi A. La comunicazione facilitata in un bambino autistico. Psicol Clin Sviluppo.2001; 5 :395 –421
16. Mirenda P. "He's not really a reader...": perspectives on supporting literacy development in individuals with autism. Top Lang Disord.2003; 4 :273
17. Blackman L. Lucy's story: Autism and Other Adventures. Brisbane, Australia: Book-in-Hand;1999
18. Broderick A, Kasa-Hendrickson C. "Say just one word at first": the emergence of reliable speech in a student labeled with autism. J Assoc Pers Sev Handicaps.2001; 26 :13 –24
19. Wurzburg G (producer/director). CNN Presents: Autism Is a World [documentary film]. Atlanta, GA: CNN and State of the Art, Inc;2004

---

PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Kliewer, C. Articles by Schneiderman, H. Search for Related Content PubMed PubMed Citation Articles by Kliewer, C. Articles by Schneiderman, H. Related Collections Neurology & Psychiatry Social Bookmarking                         What's this?