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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
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