I started writing this post last April. I have a lot of unfinished posts, thanks to my spirited 3 year old! I wrote most of it before reading Dr. Michael Chez's excellent book "Autism and It's Medical Management". I decided to quote a paragraph from his book, as noted, because I couldn't improve on perfection! Much of my description of the "experts" educations are very similar to Dr. Chez's descriptions because they are the same viewpoints of people who are in medicine and have gone through residency training. And great minds think alike! Without further ado...

It drives me nuts to keep hearing DAN doctors referred to as "autism experts". They are self-appointed "autism experts" and in no way considered as experts on ASD medical management by the medical community.

So who is an "autism expert" that is regarded as such by the medical community? It occurs to me that just because people watch "ER" or "Grey's Anatomy", they still really have no concept of what happens in Medical School and Residency and Fellowship training. In fact, in my field of OB/GYN, I still hear about midwives being equated with OB/GYNs, as if there is no real difference in their training and functioning other than the OB/GYN can wield a scalpel, usually referring to over-eagerness to "cut" in a reckless manner. You cannot compare two years of midwifery school after college to four years of medical school and four years of OB/GYN residency training with board certification.

Understanding the training that various specialists undergo is important to help understand the depth and breadth of knowledge they have. I am speaking of physicians or doctors of osteopathy, who all go to medical school. So all start out with four years of medical school, then they go on to residency training.

Developmental pediatricians first go to residency in general pediatrics for three years, then they sub-specialize in a developmental pediatric specialty program that emphasizes developmental and behavioral delays, as well as learning disabilities, for another two years. There is board certification in this sub-specialty and in general pediatrics that they can take to demonstrate their competency in these areas.

Pediatric Neurologists first go to residency in general pediatrics for three years, then they sub-specialize in neurology for another three years. They are then eligible for board certification in both pediatrics and in child neurology.

Child psychiatrists first have a year of general medicine or pediatric training (also called an internship), then do a three-year psychiatry residency and then another year of sub-specialization in child psychiatry. Their emphasis is on psychiatric conditions and behavioral conditions. Some will have more of an interest in autism, and thus will have a better understanding of it.

General pediatricians are trained for three years in pediatrics and may have some neurological training, and even some minimal autism training. They can provide medical care for general pediatric illnesses and make appropriate referrals for medical or psychological testing. They are not considered as trained experts for autism as in the above specialties. They are eligible for general pediatric boards.

Board certification is very important as it shows competence in the areas of residency training and specialty training to a certain high level standard. You have to have taken the actual residency training in a particular area in order to take the corresponding board certification test.

There are no standard medical boards or specific training requirements for "autism specialists". Most come from one of the first three categories listed above. It isn't always easy to find them, I have had some bad experiences with some who are not very knowledgeable about autism and are not interested in learning more about it. I get recommendations from other parents and I interviewed various specialists until we found our present "team" who all work together for my son's health and welfare.

Now we come to DAN doctors. They are generally in the primary care area, like pediatrics or family medicine, although there are some specialists, like an OB/GYN I have knowledge of, and an ENT I have knowledge of, who have then taken a weekend course on the "DAN protocol" and can then hang out a shingle as a "DAN doctor". There is, of course, no board certification process to ensure a proper training and high level of knowledge/practice in this, because there is no residency/specialty program for DAN doctors. Thus, they are self-proclaimed autism specialists.

So, who is the true expert in the medical management of autism? Someone who has taken three years of training in a general residency and an additional 2-3 years of specialized training and has achieved a high level of competence that is demonstrated by board certifications, or someone who has taken a three year general residency with a weekend course that is not eligible for board certification because there isn't any board to certify them for autism medical treatment?

I have gotten to know a lot of the true experts in the medical management of autism over the years. They are all dedicated to treating children with autism. The difference is that they are highly trained and are dedicated to high standards of medical care that have been proven effective through testing with good scientific protocols.

"It is important in the face of the crisis of having an autistic child that parents remain grounded and not accept at face value the testimonials of these types of practitioners (pseudo-autism specialists) and the hype they sell. Even if some of these practitioners have good intentions, they are often misled themselves. Parents must arm themselves to ask appropriate questions and be skeptical of anyone offering to cure autism, or actively marketing themselves as autism specialists." ("Autism and it's Medical Management: A Guide for Parents and Professionals" by Dr. Michael Chez, M.D., page 121)

Addendum:

Board certification is different for every specialty and sub-specialty. They each have their own organization, like mine is the American Board of OB/GYNs, and that is the only one I can receive board certification in. A physician must have residency training and Fellowship/Sub-specialty training first before they can apply for their particular board certification, and they must practice for one to two years before they can take the written and oral boards.

So, the true autism experts will have board certification in Pediatric Neurology, or in Neuro-developmental Disabilities , or in Child Psychiatry. It is important to know what the doctor is board certified in. A board certification in Pediatrics or Family Practice does not certify a doctor in the medical management of Autism. Certainly, the two doctors I know of, one in OB/GYN/Genetics and the other in ENT, have absolutely NO training at all in autism, and have no right to call themselves "autism experts".

So make sure you know what their board certification is. If they are not Board Certified in one of the three approved training programs, they are then "self-appointed" autism experts. An interest in autism and a few weekend DAN meetings do not an expert make.

DAN DOCTORS ARE NOT AUTISM EXPERTS!

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Comments:

Snu
Nov. 22, 2008 at 5:12 PM

Bravo, Karen!  You know what makes my heart sink?  When I read a post written by a mother who has just been told her child is on the spectrum.. she is scared, numb, and knows NOTHING about autism and its treatment.  Then.. then.. come the responses:  one mom raves about her DAN doctor, another starts talking about vaccines, another adds a comment about GF/CF diet, etc..  In other words, this poor mother is being bombarded with advice that is questionable at best and doesn't even know it.  Thank you for reminding us how we can evaluate all the autism treatments/"cures" being touted.

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kyles...
Nov. 22, 2008 at 8:20 PM

Amen lady!!!  It just kills me to hear people who are in "crisis"/counseling those in a "crisis" say "omg, you've got to find a DAN doctor, they'll help you!"  or "I'm going to check with the DAN doctor, THEY know."

You've always got the right stuff to share!  Thank you!

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Track...
Nov. 22, 2008 at 10:30 PM

Thank you for a very well written and well researched post.

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