I would like to comment on the November JADA cover story by Dr. Arthur Friedlander and colleagues, "The Neuropathology, Medical Management and Dental Implications of Autism" (
JADA 2006;137[11]:1517–27
). Although I agree with most of the information presented in the article, I am disappointed that the authors depicted autism in its most severe form. As I read the article, I felt that the tone was intended to portray autistic people as the stereotype played by the actor Dustin Hoffman in the movie "Rainman."
The likelihood of a general practitioner coming across a severely autistic child is rare (10 to 20 of every 10,000 births, as stated in the article). And I would presume that if the clinician would encounter a severely autistic child, he or she would refer the child to a pediatric specialist for treatment.
The fact is, autism is a "spectrum disorder" that affects individuals differently and to varying degrees of severity. Some children may have just mild sensory issues (for example, sensitivity to sound or to bright lights only, or even to tags in their shirts), whereas other children may exhibit speech delay in addition to sensory integration issues, but not nearly as severely as portrayed in the cover story.
According to the Autism Society of America,1 "as many as one out of every 166 babies born today will be diagnosed with an autism spectrum disorder, and the incidence of autism is rising. This frightening statistic led the U.S. Congress in 2002 to declare autism as a ‘national health crisis.’ Autism is more common than childhood cancer, cystic fibrosis, Down syndrome, cerebral palsy and multiple sclerosis."
The reality is that the chances are much higher (one in 166 patients) that a general dentist will be treating a child in the autistic spectrum, rather than with the severest form, as the authors described. Therefore, it is extremely important for the clinician to know where the child is on the spectrum, and to approach his or her treatment with a team effort.
Autism is different in every child and requires the clinician to employ a different treatment approach for every child affected by this disorder. Unlike the authors’ suggestion that the parents may be abnormal and "may impede the collaborative treatment process," I implore the treating dentist to actively collaborate with the parents. They know the child and are the best advocates toward a successful treatment outcome for the child.
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