Sally Ozonoff JCPP
Opening the dialogue on optimal outcomes and using the word “recovery” as a possible outcome must be done responsibly. It cannot detract attention from those who do not fall in this group, those who make less progress than hoped or achieve much smaller gains. How are these children different? How do child characteristics interact with treatment characteristics to foster the best outcomes? Broderick (2009) cautions against a “binary conceptualization of hope” (p. 270) that represents outcomes other than optimal ones as tragic and hopeless. She suggests that other optimal outcomes include emergence from isolation into engagement with the world and full participation in an ordinary life, even while retaining significant symptoms. Hope for recovery as the only hope would be not only shortsighted, it would be unethical.
But moving the possibility for recovery from ASD beyond public discourse and into scientific discourse is critical. No, recovery won’t be possible for everyone. No, recovery is not the only outcome worth fighting for. But it is high time we, as a scientific field, talked seriously about this as a possibility. As recent political events have demonstrated, hope can be a powerful tool. By demonstrating that there is solid science behind hope, we can add fuel to the urgency for very early diagnosis and intensive treatment of ASD.
So are we, as researchers and practitioners, at the stage that we can begin to use the “r” word? I would say yes. The science provided by Fein et al. and other recent articles suggest that such optimal outcomes are not simply initial misdiagnoses, nor are they just hyperbole. While many questions remain, the publication of Fein at al.’s article provides an initial scientific basis for talking openly of recovery as one possible outcome. We may not yet know how to get there, but now, we do know it is possible. The ultimate goal uniting both parents and professionals is to give each young child diagnosed with ASD the chance of this outcome, to know that no stone has gone unturned in the quest. We have exciting science ahead of us as we figure out the necessary ingredients of such outcomes.