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Understanding Autism: The Power of Asking, “What Would Happen if…?”

By Justin Gardner, PsyD.


I have always been fascinated by thought experiments. They are some of the oldest forms of logical deduction, earlier even than formal mathematics. The basis of thought experimentation is to think through “What would happen if…?” based on known initial conditions. In other words, if you know enough about how something works, you can make a relatively accurate prediction about how something will affect it even if we have never observed it before. Now, don’t get me wrong, I have a deep love and appreciation for mathematics and statistics. There is indeed a need for discreetly and repetitiously observing a specific phenomenon under specific conditions in the laboratory and then developing a mathematical formula to describe its underlying functionality. However, while statistical analysis serves a necessary function in increasing confidence in our knowledge of an already identified phenomenon, it often falls short of allowing us the flexibility to apply critical thought to identify areas of individual need.


During this year’s National Autism Acceptance Month, I think back on how far we have come in understanding, identifying, and treating Autism Spectrum Disorder (ASD). Nevertheless, there yet remains much work to be done. I often talk to psychologists, neuropsychologists, school psychologists, and other clinical providers who voice concerns about the historical practice of providing a “broad-brush approach” to the recommendations offered to patients who have ASD. For example, many providers scour online research databases to create a comprehensive list of “tried-and-true” treatments to give to their patients who have ASD–such as Applied Behavior Analysis (ABA), speech/language therapy, psychiatry, occupational therapy (OT), physical therapy (PT), social skills training, among a list of other research-backed treatment modalities. The logic is that if a child has ASD, then they have multiple “brain-based” deficits in numerous social and behavioral skills that must be remediated for them to be able to function in a less encumbered manner. Thus, it follows from this principle that the practice of “early-and-often” intervention reigns supreme: it all must be treated simultaneously and as quickly as possible.


While such a practice has its place, let’s insert a quick thought experiment to test the boundaries – “Do we really need to treat everything all at once?” Wouldn’t doing so be immensely time consuming, financially expensive, and physically/emotionally draining for the person with ASD as well as their caregivers? Rather, let’s consider another thought experiment: what is the smallest set of treatments that would produce maximal treatment outcomes? Metaphorically, “Which bowling ball would knock down the most pins first?” In borrowing from colleagues in the field of systems biology, we may not need to target every possible symptom individually and all at once. Rather, if we first treat the most centralized symptom (i.e., that which is causing the most exacerbations across all inter-related symptoms), then the person often has wide-reaching improvements – even in those areas that were not directly treated. Now we are talking about treatment efficiency, or “getting the most bang for your mental health buck.”


Let’s do another thought experiment – “What would happen if… we only directly treated poor attention in a child with ASD, perhaps via the use of stimulant medication?” The obvious first outcome would be improved attention. However, what else would happen? Based on what we know about neuropsychology, if a child who has ASD can better pay attention, then they will be able to better pay attention to social cues, to other people’s feelings, and to how their behaviors affect other people – thereby remediating several ASD-specific symptoms without treating them directly. In other words, by being thoughtful about which symptom to treat first, we put into motion a host of cascading positive outcomes. In addition, the added benefit (at least in this case) of first treating poor attention is that the child will be able to pay attention more fully during other subsequent treatments, such as ABA, OT, and others – and thus get more out of them.


Such a process is no more evident than in the treatment of ASD in the gifted population. The neuropsychological profiles of those with milder forms of ASD are so similar to those who do not have ASD that they may only require a limited set of treatments. I often find that the most centralized set of ASD-related symptoms are in relation to cognitive inflexibility and theory of mind (taking others’ perspectives). Even though gifted children with ASD tend to have more than just these two symptoms, it is their cognitive inflexibility and difficulty with theory of mind that causes impairment. Therefore, “What would happen if… we only directly treated cognitive inflexibility and theory of mind in a gifted child with ASD?” In my own clinical experience, that’s all it takes for them to get to a place where their ASD is “imperceptible” and is more of an “artifact” of who they are rather than a diagnosis.


We have come a long way in our understanding of ASD and in the tools developed to treat it. However, as we continue to look forward, let us remember that treatment is not necessarily about quantity–it’s about quality and timing. Quality and timing are in turn dependent on our willingness to take a step back, roll up our sleeves, and think critically about how we treat, parent, and educate those with Autism. I encourage us all to never stop asking ourselves, “What would happen if…?”

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Justin Gardner, PsyD is currently finishing his Post-Doctoral fellowship under the supervision of Paul Beljan, PsyD, ABPdN, ABN at Beljan Psychological Services in Scottsdale, Arizona. Dr. Gardner completed his doctorate in Clinical Psychology from Midwestern University in Glendale Arizona. He completed his internship at The Rochester Institute of Technology where he developed computational modeling approaches for diagnosing and predicting maximal treatment outcomes for Posttraumatic Stress Disorder, Autism Spectrum Disorder, and chronic pain.


Dr. Gardner is passionate about conducting research. He has been invited to present at numerous local, national, and international conferences regarding his research into the use of artificial intelligence, computational modeling, and other algorithmic approaches to the diagnostic process of various neuropsychological disorders. Dr. Gardner has published several research articles in peer-reviewed journals on topics ranging from giftedness, math learning disorder, executive functioning, computational modeling, and artificial intelligence. First and foremost, Dr. Gardner is a clinician.


He spends most of his time seeing patients at his offices in Scottsdale and Chandler, Arizona. Dr. Gardner specializes in providing neuropsychological evaluations and psychotherapy to children, adolescents, and adults with wide ranging backgrounds and mental health needs.


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I agree with what this article wants to transform for the reader. Focusing on the core symptoms that cause the most Buckshot Roulette problems seems much more effective than a broad-brush approach.

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