In Reply

In response to our article,¹ Eigsti et al note that they share our concern about systematic discrimination in the education and employment of individuals with diverse abilities. Bernard et al underscore the need for therapeutic interventions for autism to be neurodiversity affirmative.

Eigsti et al also note that, having worked with a wide cross-section of parents of autistic children, they have rarely heard parents express reservations about early intervention, particularly as related to appreciation for neurodiversity in these programs. Our experience is that parents are becoming aware of the controversies surrounding early intervention methods,^2,3 and they are more often raising questions about the intervention approaches used. We have heard such questions from parents in our clinic, families who participate in our research studies, and stakeholders on our center’s community engagement advisory board. These concerns prompted our center, in collaboration with the TEACCH Autism Program at the University of North Carolina at Chapel Hill and the Autism Society of North Carolina, to host an informational program designed to answer parents’ questions and concerns about autism early intervention methods. Recently, the Autism Society of America hosted a series of virtual town halls—one each for parents, professionals, and self-advocates—to allow people to share their perspectives, questions, and concerns about autism interventions, particularly the use of applied behavior analysis. Many of the concerns raised echoed those described by Bernard et al, while the benefits of early intervention were emphasized by others. Increasingly, we are providing services for autistic parents who have autistic children and often express reluctance to enroll their child in early intervention programs that do not closely align with their values related to neurodiversity. These issues are well articulated by Loo et al,⁴ who describe a family comprising 2 autistic parents and their autistic toddler. These authors thoughtfully discuss how professionals can assist families in identification of priorities for care for their child while ensuring respect for their perspective of neurodiversity. At our center, it is not uncommon for parents of school-aged children and adolescents to ask whether our intervention approaches support a strong sense of positive self-identity as an autistic person and promote self-advocacy skills.

Like Eigsti et al, we work with families from diverse racial, ethnic, gender identity, education, insurance, and income backgrounds. We agree with Eigsti et al that families of multiply marginalized autistic children often face a variety of barriers to receiving adequate services and that ensuring equal access is critical. Our article¹ is not meant to cast doubt on the value of early intervention, but to reassure self-advocates, parents, and professionals that early intervention practices and neurodiversity perspectives can be reconciled and share common values and goals for improving quality of life for autistic individuals. Continued dialogue and collaboration among different stakeholders, including those who hold dual positions as medical professionals and members of the autistic community, are essential.