Governments Treating Autism: How Far Should the State Go to Pay for Developmental Disorder Interventions?

In a story out of California, a mother caught her child's autism very early, shortly after birth. Today, the child is doing quite well, making breakthrough after breakthrough, and he may be on track to overcome his autism for the most part by the time he reaches school.

To do this, the state of California has been paying $70,000 a year: for 36 hours of work per week by graduate students who come in every day to work with the boy; for outside therapists to treat him; and for some special interventions: repetitive motion, rewards like praise and treats, swinging and other forms of play that get the child excited, and special rewards when certain benchmarks are made - such as making sounds that can be put together into language.

It is wonderful that autism treatment has advanced to the point that, through early and consistent intervention, babies who are highly at risk can be turned around at that early phase. But with the sudden enormous apparent epidemic of autistic children, how long can any state sustain the cost of treatment for these children when insurance will not pay for it (and most won't)?

More importantly, do interventions for these children take money from other, more worthy programs? And can the parents be trained to use these interventions instead, freeing up funding for other programs?

Train-the-Parent Instead?

Right now, autism costs us all $90 billion a year, and that number is expected to double in a decade. Why? No one really knows. Some say it's because of food and immunization allergies, or geek-marrying-geek syndrome, or indigo children, or pollution. Most likely, though, it is primarily because we are getting increasingly good at identifying borderline cases, and properly diagnosing cases that once were categorized as mental retardation or other issues.

Currently, there are over 20,000 children with autism in California, each of whom is eligible for that $70,000 a year intervention. That adds up to a huge chunk of California's already-bloated budget. Taxpayers who really can't afford it anymore are being required to pay for this expensive treatment - and if the statistics put out by autism researchers are correct, they can only expect things to get worse for at least a decade.

Here's my problem: parents give birth to children. Just like marriage, when you commit to having that child, it's for better or for worse. No matter what condition that child comes out in, he's your child, and your ultimate responsibility. He is not the responsibility of the state - nor should he be. We are human beings, and perfectly capable of living up to our respective responsibilities.

Hundreds of thousands of people in the United States sacrifice career, social life, even marriages to care for family members who can't care for themselves: Alzheimers patients, mentally-disabled siblings, handicapped children and spouses. That's the way it is. I very much doubt they are receiving $70,000 in care from their respective states.

Why can't the parents of these autistic children sacrifice a little more, just like those other hundreds of thousands of citizens?

Don't get me wrong. Autism research and treatment is one of the great challenges facing us today. I am on the autism spectrum; my youngest son is diagnosed PDD/NOS. As a parent, I find it very difficult to deal with myself.

But by divorcing treatment from the family, as this level of intervention does, are there not negative consequences? Shouldn't the mother be getting this close to her autistic child, instead of using a constant stream of graduate students who are not only being paid but using that child as a research tool?

Instead of investing so much money per child, would it not make sense to train the mother or father in how to perform these interventions? They are simple things, involving carefully-directed play and special types of communication. The parents should be learning how to do these things anyway, so that the child is not cut off again once the therapist is gone.

Then, instead of a therapist coming every day, a parent can sacrifice part of his or her time, in return for a state stipend that helps pay for lost wage expenses and any special equipment the child requires. A therapist can visit once a week for updates, checking the child's progress and recommending additional interventions - basically, training the parent weekly on what he or she needs to do to ensure the child's progress. If no progress is being made, then the therapist could consider more intensive interventions.

There are two ways to look at the results of this. Either the parent will rise to the challenge and turn out a much better child than a therapist ever could - or the parent will fail utterly through lack of trying or even through abuse of the system. A weekly visit by a therapist should catch extreme failures before they become disastrous, and help guide the successes. Overall, with the parent, not the therapist, focusing on the child, is it not reasonable to expect that the children will do better overall?

The freed-up money could then be spent on the hundreds of other programs that really could use more specialized treatment: physical disabilities, the sick elderly, job training programs, English language programs, etc. We really do have a limited pie to divide up here; a wiser use of resources, including family resources, could ensure that others who desperately need help can get it.