Dayton

Dr. Pittman was nearing the end of her shift at a busy community clinic on a Friday afternoon. Her last appointment was with a new patient, Dayton, a 6-year-old boy who, according to his parents, had an earache. Dr. Pittman quickly diagnosed otitis media and talked with Dayton’s parents about treatment.

            Dayton’s behavior troubled Dr. Pittman far more than his inflamed eardrum. He did not make eye contact or respond to her questions. He flinched whenever she approached him, cried out in fear when she peered in his ear with an otoscope, and hopped up and down, shaking his hands compulsively, several times during the visit. When Dr. Pittman questioned Dayton’s parents about his behavior, they told her he had been diagnosed with autism at age 4. His development, they said, was delayed.

            She asked what treatment Dayton’s parents had sought for him, and the answer shocked her. They were members of the autism self-advocacy movement and believed that Dayton’s condition was simply an example of neurodiversity and was not pathologic. They clearly adored their son, doting on him during the clinic visit and telling Dr. Pittman how they home-schooled him after the public school system failed to meet his social and educational needs. They accepted Dayton as he was and were determined to provide him with lifetime care.

            Dr. Pittman viewed Dayton’s situation differently. She knew that with proper therapy and medication his condition could improve considerably—but only if treatment were begun as soon as possible. She worked at a nearby autism clinic, where Dayton could probably qualify for long-term treatment. When she mentioned this to Dayton’s parents, they wanted nothing to do with it. They were adamant in their belief that Dayton’s condition required no medical intervention. Dr. Pittman had encountered many adult patients with culture-based opinions about their health problems that she found hard to understand, but this was the first time she’d disagreed so fundamentally with parents about a situation that she believed would harm their child by limiting his future opportunities. She fought the urge to reprimand them for what she considered their neglect of his debilitating developmental problem. Did their treatment constitute child endangerment, she wondered? Would she be justified in contacting a child protection agency?



*http://virtualmentor.ama-assn.org/2010/11/pdf/ccas1-1011.pdf