Ethics in the Diagnosis and Treatment of Autism

The level of debate over autism spectrum disorder belies its relatively short history among recognized diagnoses. Since the first US use of the term in the 1940s, much disagreement has been voiced about its causes, whether it is an illness or a feature of our neurodiversity, and how best to support those who have the diagnosis. Contributors to the April issue of the AMA Journal of Ethics explain current and historical perspectives on these contested issues. We are also pleased to have a sample of artwork by people with autism in this issue.

Volume 17, Number 4: 287-406 Full Issue PDF
  • From the Editor
    Apr 2015

    The Autism Paradox

    Kathleen K. Miller, MD
    Two truths about autism exist in uncomfortable tension: it can be devastating and it is not a disease.
    AMA J Ethics. 2015;17(4):297-298. doi: 10.1001/journalofethics.2015.17.4.fred1-1504.
  • Case and Commentary
    Apr 2015

    Conflicts in Family-Centered Pediatric Care for Patients with Autism

    Jeffrey P. Brosco, MD, PhD
    In treating children with autism, physicians should reframe the common dynamic in which the family wants medication that the doctor is withholding to focus instead on the family’s and physician’s share goal—the patient’s well-being.
    AMA J Ethics. 2015;17(4):299-304. doi: 10.1001/journalofethics.2015.17.4.ecas1-1504.
  • Case and Commentary
    Apr 2015

    Autonomy and Autism: Who Speaks for the Adolescent Patient?

    Rebecca Benson, MD, PhD and Catherina Pinnaro, MD
    Minors, including those with autism, have the right in certain states to make decisions about their own medical care provided they meet certain criteria. Even in cases in which the “mature minor exception” does not apply, physicians should actively engage patients in discussion of their treatment.
    AMA J Ethics. 2015;17(4):305-309. doi: 10.1001/journalofethics.2015.17.4.ecas2-1504.
  • Case and Commentary
    Apr 2015

    Communicating Concern about Early Signs of Autism to Parents

    William D. Graf, MD
    In treating children with autism, physicians should focus on involving parents in a shared decision making partnership and seeking safe, evidence-based, and medically and cost-effective treatments.
    AMA J Ethics. 2015;17(4):310-317. doi: 10.1001/journalofethics.2015.17.4.ecas3-1504.
  • Medical Education
    Apr 2015

    Autism Education in Residency Training Programs

    Nili E. Major, MD
    Evaluation of an autism curriculum for pediatric residents yielded significant short-term gains in residents’ objective and self-assessed knowledge of autism spectrum disorder diagnosis and treatment.
    AMA J Ethics. 2015;17(4):318-322. doi: 10.1001/journalofethics.2015.17.4.medu1-1504.
  • In the Literature
    Apr 2015

    On Risks and Reality: Communicating the Difference between Autism Risks and Diagnosis

    Matthew A. Rysavy and Jody R. Murph, MD, MS
    The harms of communicating autism risk can be avoided by helping families to understand risk and to distinguish between poor and good sources of scientific information, which should take families’ interests into account.
    AMA J Ethics. 2015;17(4):323-327. doi: 10.1001/journalofethics.2015.17.4.nlit1-1504.
  • Policy Forum
    Apr 2015

    A Life of One’s Own: Challenges in the Transition from Childhood to Adulthood with Autism Spectrum Disorder

    Kayhan Parsi, JD, PhD and Nanette Elster, JD, MPH
    The need for improved health care transition (HCT) for youth with autism spectrum disorder (ASD) can be met with training for health care professionals, financial counseling for parents of children with ASD, and increased vocational training and opportunities for youth with ASD.
    AMA J Ethics. 2015;17(4):342-347. doi: 10.1001/journalofethics.2015.17.4.pfor1-1504.
  • Medicine and Society
    Apr 2015

    The Myth of the Normal Brain: Embracing Neurodiversity

    Thomas Armstrong, PhD
    A judicious approach to autism would be to replace a “disability” or “illness” paradigm with a “diversity” perspective that takes into account both strengths and weaknesses and the idea that variation can be positive in and of itself.
    AMA J Ethics. 2015;17(4):348-352. doi: 10.1001/journalofethics.2015.17.4.msoc1-1504.
  • History of Medicine
    Apr 2015

    Mothers and Autism: The Evolution of a Discourse of Blame

    Mitzi M. Waltz, PhD
    Although now discredited, the idea that mothers’ behavior is responsible for autism lives on in the social pressure that mothers feel to save their autistic children, at a cost to both the self-blaming parents and people with autism.
    AMA J Ethics. 2015;17(4):353-358. doi: 10.1001/journalofethics.2015.17.4.mhst1-1504.
  • Art of Medicine
    Apr 2015

    Drawing Autism: Showcasing the Artistic Talents of People with Autism

    Jill Mullin, MA, MSEd
    Drawing Autism, a collection of drawings and paintings by people diagnosed with autism, demonstrates an array of talent and themes as well as providing insight into the artists and autism spectrum disorder.
    AMA J Ethics. 2015;17(4):359-361. doi: 10.1001/journalofethics.2015.17.4.imhl1-1504.
  • Art of Medicine
    Apr 2015

    Artwork by People with Autism

    D.J. Svoboda, Kevin Hosseini, Noah Schneider, Emily Casanova, PhD, and Kay Aitch
    Kevin Hosseini’s painting of his tutor’s dog, Bella.
    AMA J Ethics. 2015;17(4):362-368. doi: 10.1001/journalofethics.2015.17.4.imhl2-1504.
  • Viewpoint
    Apr 2015

    Complementary and Alternative Treatments for Autism Part 2: Identifying and Avoiding Non-Evidence-Based Treatments

    Alison Singer, MBA and Ramita Ravi
    Because many complementary and alternative medicine therapies for autism are based on misguided notions of its cause and lack support from scientifically sound studies, physicians should steer parents away from these practices and toward safe, effective, and evidence-based interventions.
    AMA J Ethics. 2015;17(4):375-380. doi: 10.1001/journalofethics.2015.17.4.sect2-1504
  • Viewpoint
    Apr 2015

    Making Ethical Progress without Ethical Theories

    Dien Ho, PhD
    The default principle—that someone is free to do what he or she desires in the absence of a compelling reason why he or she should not—may make it possible to resolve ethical disputes without recourse to a particular moral framework.
    AMA J Ethics. 2015;17(4):289-296. doi: 10.1001/journalofethics.2015.17.4.spec1-1504.