Dr. Margaret Bauman is a Child Neurologist, currently on staff at the Boston University School of Medicine
Here, Dr. Bauman provides an historical perspective on some of the work she’s done in the United States on the Autism Spectrum Disorder.
Hi, my name is Margaret Bauman. I am a child neurologist, formerly of the Massachusetts General Hospital and the Harvard Medical School and currently on staff at the Boston University School of Medicine. I'm also a participant and on the board of the Forum for Autism and I'm delighted to be able to speak with you briefly today about some of the work that we're doing in the United States as it relates to the autism spectrum disorder. I came into the autism field in the early 1980s when I was working with my colleague and at the Boston University School of Medicine looking at post-mortem brain of individuals on the autism spectrum in comparison to those who were typically developing. At that time, there was still the idea that autism was caused by poor parenting. There was this phrase in the United States about the refrigerator mother and that if, in fact, the child was autistic that it has meant that this was a bad mother. Our work in 1985, which was eventually published at that time, showed clearly that there were abnormalities in the brain of an individual with autism and that this was a disorder that probably began before birth. Since that time, the field of autism has changed dramatically, not only in the United States, but elsewhere as well and much of this is attributed, in part, to some of the work that the Autism's Forum is also participating in. But in terms of what's happened over the years in the United States, there's been a big push for early intervention and early identification and the research has fully supported the idea that if we can identify these children as early as possible and give them intensive services, that their outcomes, developmentally, will be substantially better. And the research fully supports that contention. One of the major modes of treatment, as most of you are aware, is what's called applied behavioral analysis or ABA. This works for many, many children, but it is not working for everybody. There are other approaches that can be used, some of which are called a developmental approach or otherwise known, in the states at least, as floor time. Some investigators, some providers will use both of those approaches, but it really depends upon the child and what works for each child. There is a trite phrase in the field right now which is something like, if you've seen one child with autism, you've seen one child with autism, which basically means that this is a very heterogeneous disorder and no one child is like any other and they all have to be treated individually. Over the years, we've also gone beyond simply the clinical implications here and now there's a growing body of science that's coming into the field, largely directed towards trying to understand the underpinnings of the disorder, what's its case, and if we can define the causes better, how can we treat it more effectively other than just through our ABA therapies, our speech and language therapies, the occupational therapy that we use and so forth. Much of it has been the big focus, recently now, has become on what are called biomarkers. We're trying to determine if we can come up with a blood test, a urine test, a saliva test, some kind of test to define these children from a biological perspective. And so therefore, identify them sooner and therefor, get services to them sooner, hopefully again, with better outcomes. Another area that's blooming now in the United States is the concern that females with the disorder have been under diagnosed. This is a disorder that, for years, has been always seen as largely a male dominated disorder. The ration being four males to one female, usually. I think the consensus at this time is that when Dr. Cantor, who first defined this disorder back in 1943 described it, he described males. Consequently, a lot of the measures that we use to define the disorder, including the autism diagnostic interview, and the autism diagnostic observational schedule, are clearly defined for males. I think there is now a growing appreciation that feels females present somewhat differently and we are now spending a lot more time trying to figure out how to define females more precisely in order to give them the services that they need that many of them, quite frankly, have missed out on when they were younger. Another area of interest is adults. Clearly we've got many, many young children, and children happen to grow up. Up to this point, or probably within the last five, six years before that time, everybody has been concentrating on early diagnosis and treatment for children. But the real problem now is what are we going to do about those who are teenagers who are transitioning into adulthood and what are the differences between adults and what kind of health care needs do they have, how do you find meaningful employment for them, and where should they live and who's going to be responsible for them and so forth. I think there is a growing need right now to really begin to study that area in order to have these young people have a very productive life which they're very good at. Many of them also have been non-verbal and with the growing advent of technology, we are now using communication devices so that those who are non-verbal can speak to us using their devices. It's turned out that individual that we thought really didn't have good cognitive skills because they couldn't speak are, in fact, very bright and can speak to us through their devices. There are many, many things that are happening here, many areas that are opening up for individuals on the autism spectrum, as they become adults, and I think the future really, in many ways, is quite bright, although we've got such work to be done. I hope that those of you who are attending this conference will learn a lot about autism, will have a chance to learn about what some of the new strategies are for working with children and adults on the spectrum and that you will help us and others to advance the field and to provide meaningful lives and productive lives for those who really are, in many ways, extremely talented, only in a slightly different way than the rest of us. Thank you very much and it's been an opportunity to speak with you. Thank you.