Ethical Issues in Early Intervention

Abstract

Our purpose is to introduce a range of issues concerning early interventions for children with autism that might, but need not, be construed as ethical issues. Framing them as ethical issues draws attention to their importance, but also is apt to generate counterproductive emotional responding. For example, in discussing the evidence for the effectiveness of early interventions, we note that the scientific evidence of effectiveness often is relatively weak. As a case in point, although aripiprazole (Abilify) and risperidone (Risperdal) are approved by the US Food and Drug Administration for treating "irritability" in children with autism, the studies on which approval was based lasted for only 2 months and there are no data regarding the effects of these drugs when taken for long periods beginning early in life. Anyone who prescribes aripiprazole or risperidone as an early intervention for children with autism is making a leap of faith in the hope that doing so meaningfully benefits the children. There is certainly a possibility that the quality of a child's life will be improved substantially by the drug, and that is why the physician prescribes it. But there is also a possibility that a given patient will be harmed in the long run, although the probability that such harm will occur cannot accurately be specified when treatment is delivered. A physician's decision to prescribe or not prescribe aripiprazole or risperidone for a young child with autism who exhibits high levels of inappropriate behavior could be construed as an ethical issue, and she or he could (but in our view should not) be accused of behaving unethically if the wrong choice is made. But what is the wrong choice? The answer, of course, is likely to depend upon whom one asks and our opinion is of no special importance. We are not arbiters of ethical conduct and, save for what should be an unnecessary warning against gross malfeasance or implementing treatments that are clearly harmful or valueless, we make no attempt to dictate which early intervention practices are and are not ethical. We do note, however, that there is much worthy of consideration when the topic is opened to full and fair discussion. (PsycInfo Database Record (c) 2021 APA, all rights reserved)