Educational or Medical?
November 7, 2008 by Kristina Chew, PhD
Filed under Health
How to characterize services/”treatment” that’s educational in nature (like speech therapy; like ABA, in some ways): How to argue that it’s “medically” necessary? In a November 6th ABC local news report about how a Fremont (CA) mother took on the health care policy of the HMO Kaiser, Kristin Jacobsen of the Alliance of California Autism Organizations says:
“I think one of the biggest tragedies is the health plans are for profit businesses. They make a lot of money, they collect premiums, these families pay premiums and they expect to get health insurance coverage,” said ….. Jacobsen ……….. She says Kaiser is not alone in passing off responsibilities for treatment to school districts and regional centers.
“This is a medical condition. There’s definitely an educational component that needs to be addressed by the school districts, but it’s a medical condition,” said Jacobsen.
Keeping in mind medical-physical concerns along with educational ones has been crucial for Jim and me in figuring out how to help, teach, and understand Charlie. But it’s been particularly important that Charlie’s gotten that medical/educational treatment/teaching/services in a school setting, in which the emphasis is on learning, not on getting “better” to the point when treatment might not be needed anymore and the diagnosis lost. Is there a danger in over-emphasizing that autism is a “medical condition” (while, of course, noting that many autistic individuals do have medical conditions requiring care and attention)?
Nothing that is educational is medical.
Nothing to do with autism is medical.
It is just a trope, a fixation borne of historical circumstance. Metanoia is not a disease yet…
Erewhon (you are a literateur so I guess you know the reference)
And Education is a human right, we are not educated in hospitals by doctors so why is autism different?
The irony is not lost on me of course, since Dr for a medical practitioner is just a courtesy title, not an actual qualification.
Doctor as you well know originally implies one who teaches, Rabbi, or Guru if you will.
A doctorate is still a qualification to teach in it’s original meaning,
As for the meaning of cure, bacon apart, it is what a minister of the Church does for his parish. Quem Quearitis? Caritas
I’ve thought through this quite a bit the past year and read studies and blogs and books on both sides of the argument. My concern was that my daughter with autism also had quite a few medical concerns. GI issues being a big one, as well as what seemed like a bit of total body shutdown when introduced to stress of any kind. On the GI front, of course there was the whole GFCF diet and then a recent GI specialist tell me that he thought nothing was medically wrong, only that she had autism and the nervous system can do crazy things when the body is stressed (and with autism, there is quite a bit of anxiety in a variety of settings he said) and explained the medical concerns away as being caused by autism. If the medical concerns (GI issues that were thought to be causing the failure to thrive) were caused by autism, and the only help I would get with any public funds were through the education system, I can see the argument in some ways I guess. Otherwise, without this help, my daughter wouldn’t get any help as we can’t afford private therapies and would (according to her GI) continue to experience the GI issues and the failure to thrive and the reactions her body seemed to have to stressful situations.
Recently, we learned she has mitochondrial disease. It explains all of her medical concerns, including the GI issues. This has nothing at all to do with the autism. Or at least it means the autism isn’t causing the medical issues and the autism traits aren’t a “medical” concern. It also means it isn’t the cause for the failure to thrive, the GI issues and the way her body physically responds to stress. Thus it isn’t an educational issue. Certainly, if she were to attend public school, there are some things regarding her medical care that would need to be addressed with the IHP and maybe even the IEP. But that doesn’t make autism a medical issue.
@laurentius-rex — your use of language is a delight.
I do wish, though, that I knew which aspects of those characteristics that came together to form my daughter’s autism diagnosis are expressions of “who she is” that should be taken into account for her education — and which are expressions of medical issues (such as her seizures).
I also find myself very much resenting the fact that, while autism is currently framed as a medical/psychiatric diagnosis, insurance companies bend over backwards not to have anything to do with it once the diagnosis is given… at least, in states where they’re allowed to get away with it.
Medical issues are medical issues, we all, NT autistic or whatever have medical issues at some time in our lives and they should be treated as such.
Taking a wider perspective than autism, because not many people realise that the debates that seem to be unique to autism are not at all, the problem historically with much “special” or segregated education for disabled children has been that the focus has been too much on medical care and not enough on education per se, in that although the care might have been superior to what would have been available in main stream schools never mind the access, the academic focus was not there and many children left special schools with a lower level of attainment compared with what they were capable of, adding to the disadvantage of disability in the social and employment fields.
Education for autistics does need an appropriate focus, but one should not mistake that for a medical need, it is a cognitive need, driven by the different cognition of an autistic brain.
It’s not medical, it needs educational specialists with a proper understanding of autism.
Well, from a school psychology point of view, autism is different from say, ADHD, in that there is no medical treatment for it (there are drugs that do directly help ADHD – the drugs that some autistic people take are helping co-morbid conditions, not the autism itself.) Hence, a school psych can diagnose autism/asperger’s, but cannot diagnose ADHD.
I have always thought of it as a developmental disorder – medical in as much as it is something more than just an educational issue, but it is not progressive as most ‘diseases’ are (arguments aside from those who have seen their child with late-onset autism regress, rather than those that seem to have just ‘always’ been that way). Also not medical in as much as there is nothing you can do to ‘fix’ it. You might be able to alleviate the symptoms, but you cannot rewire your child’s brain.
‘I do wish, though, that I knew which aspects of those characteristics that came together to form my daughter’s autism diagnosis are expressions of ‘who she is’ that should be taken into account for her education — and which are expressions of medical issues (such as her seizures).”
It’s an interesting question. I would categorically reject much of the rhetoric Karin is using. But I’m also going to give a different prespective than Laurentius.
From where I sit, there are medical conditions that are separate from autism but are more likely to show themselves in an autistic for any number of reasons. I think what’s key here, though, is a form of invocation in “medical” that makes it hard to describe some of the effects. For example, let’s say that someone is extremely stressed by the death of a relative and develops an ulcer. That’s a medical problem, sure. But it’s also a function of something that’s decidedly not, that of a sense of sentimentality and stress management ability. Neither of those are medical problems, but do directly cause the medical issue at hand.
So is it a medical problem at root? Or an effectively educational issue (and it is educational; learning how to manage certain kind of situations and how to distinguish certain things from others are not prior to social mechanisms) that then complicates itself into a medical problem? I say the latter.
Ok, but what am I saying about autism? Well, something more akin to Laurentius, but not going as far to make it all a function of the terminology used, because it’s clearly not (like in the case of seizures or some of the frequently reported stomach issues). But I wouldn’t call them all co-morbid conditions, because not all of them actually are. Now, autism itself isn’t a medical issue; Laurentius has that right. There may be more likely to come up with an autistic neurological type; that would be the seizures. But that’s not autism itself, nor described by autism itself. And there are other issues yet which have much more with something about the way in which one processes the environment, with the possibility that the regulation mechanisms that aren’t imparted to an autistic neurological type can be, which means that “medical” issue can be educated out of existence, as odd as that sounds.
Now, can I broadly say which is which? Nope. I can guess, as a person on the spectrum and as otherwise a philosopher, which is which on an individual basis, but there’s no hard and fast rule.
Cliff
I should qualify that prior comment, after I read it back to myself.
I wasn’t being programmatic about any particular issue, either. It’s complicated, easily said. But I wouldn’t invoke autism as a medical issue per se. And there are frequently things that are assumed into autism that aren’t part of it at all (see Laura’s comment, which is admittedly in direct opposition to mine). But I wouldn’t construe that divide entirely, either. There have been times I have had “medical issues” that, in a sense, really weren’t medical issues in a traditional sense, and were really a function of stress. It happens.
But none of those “medical issues” (prior or former in the prior comment’s divide) are really specific to autism. Even if you wanted to dig out higher correlation numbers in some of those cases (and, though some of us here might be loathe to admit it, one could drag those numbers out), it’s not really a function of the condition itself. It’s, at best, the way that condition interacts with a different environment, or just in others a completely unrelated condition.
Cliff
“Is there a danger in over-emphasizing that autism is a “medical condition” …” ABSOLUTELY, YES.
I am in full agreement with L-Rex’s statement:
“Education for autistics does need an appropriate focus, but one should not mistake that for a medical need, it is a cognitive need, driven by the different cognition of an autistic brain.
It’s not medical, it needs educational specialists with a proper understanding of autism.”
When we allow the medical manifestations (whether or not they are directly related to the autism, who can say?) to take first seat, it lets the school system off the hook for not only providing resources but for providing a truly individualized ed. plan which would help the child make the best, most effective use of his or her unique learning style, cognitive or physical attributes, etc.
It also means that school come to rely on the cookie-cutter diagnositc criteria. My own son was not deemed eligible for the state autism program b/c he is “social and affeectionate.” Never mind the fact that he has minimal (but developing) nonverbal communication skill, minimal self-help skills, and some significant perseverative and self-injurious behaviors whic interfere with his ability to function in a typical school environment. Nope. He’s “social” (he’ll clap the hands of anyone who will let him) and “affectionate” (indiscriminately so in most cases). School would barely provide speech services and OT/PT was at a minimal level as well. They wanted to chalk everything up to “medical necessity” and wouldn’t budge.
He is now being home schooled.
The need for a medical explanation has often meant that we’ve had to go quite out of our way to see a doctor or dentist and get a check-up, all in the name of being able to say for certain that something “internal” is not the cause of “behavior trouble.” Whether or now it’s determined something is going on, a child needs, still, very very much, of necessity, to be (yes indeed, l-rex) taught.
Ms Chew
As I understand it your son is autistic. Does he have a medical diagnosis of a Pervasive Developmental Disorder or is “autism just a label affixed by his educators?
Also, are you aware that ABA as an autism intervention is recommended by such medical agencies as the office of the US Surgeon General, the NY State Department of Health and the American Academy of Pediatrics?