Whoa......... Maurine check this out.....

[Guest guest]

When It Comes to Autism, Must we " Pay Now or Pay Later? "

Sunday October 26, 2008

http://autism.about.com/b/2008/10/26/when-it-comes-to-autism-must-we-pay-now-or-\

pay-later.htm

In a recent Google search, I came across an editorial in the Augusta

Chronicle. The editorial focused on the likelihood that services for

children with autism were slated to be cut in South Carolina -

something which many of us will be facing in months to come. What

struck me about the argument, though, was not the sense of outrage

which many do (or soon will) feel. Rather, it was the argument made by

the editorial's author, Maurine Meleck:

What they don't realize is that cutting these programs that are

helping so many children will only come back to slap all of us in the

face later. When these tens of thousands of autistic children all over

the country don't receive early intervention and they reach the age of

18, the taxpayers are going to be hit with monumental costs to help

the state pay for their care. We are talking trillions of dollars.

Meleck is certainly not the first to make this argument - that we must

pay now (for intensive early intervention) or pay later (for adult

residential and care services). By comparing the costs, of, say, three

years of early intervention to decades of adult care, it's easy to

show that it's smarter to pay for early intervention. But only, of

course, if it's also easy to show that early intervention will

guarantee that no adult services will be needed.

Unfortunately, such is not the case.

Yes, it is very likely indeed that intensive early intervention (in

the form of behavioral therapy, social skills therapy, speech therapy,

play therapy, and so forth), to the tune of tens of thousands of

dollars per year, will have a positive impact on any child with

autism. Many children who receive early intervention are able to

function in a typical classroom -most with accomodations and supports

- for at least the first few years of elementary school.

But there is very little evidence to suggest that early intervention

is the key to independent adult functioning for the majority of people

with autism. A quick search of Pubmed.com (all NIH-funded papers)

turned up nothing at all regarding the impact of early intervention on

adult functioning. NIH itself supports the idea of early intervention,

but only because it results in " improved " outcomes, and not because it

results in independence for adults on the autism spectrum.

Even worse, perhaps, we don't know which children will respond to

which form of early intervention - and we certainly don't know how

much progress any given child will make. I've often heard doctors

remark on surprisingly positive outcomes for children who seemed

profoundly disabled. At the same time, I've also heard of situations

in which apparently very capable children on the autism spectrum hit

roadblocks or developed new issues which compromised their progress.

So, is " pay now or pay later " a reasonable argument when pushing for

early intervention services? In my opinion, such an argument is

jumping the gun, when there's really no solid evidence that early

intervention for toddlers = independent functioning for adults. In

fact, there's no guarantee that any particular intervention will lead

to any particular outcome for any individual child.

Without the " pay now or pay later " argument, though, how do we justify

huge public bills for early intervention? How do we know it's " worth

it? " The answer, I think, won't come from a cost-benefit analysis.