Reflection on the Ethics of Early Intervention of Infants with the Prodrome of Autism: A Temporal-Neurodevelopmental Perspective

17 Nov 2019
09:45 - 10:15

Reflection on the Ethics of Early Intervention of Infants with the Prodrome of Autism: A Temporal-Neurodevelopmental Perspective

Objective:
Increased awareness regarding the therapeutic importance of early intervention for infants with the prodrome of autism raises important ethical issues. For example, reflection on the ethics of early intervention before the age of 18 months prior to the age when the diagnosis of autism can reliably be confirmed, yet during a period of maximal neuronal development, reveals a tension between the therapeutic imperative for early intervention and epistemic uncertainty. Moreover, the classical ethical analysis of early intervention in terms of risks versus benefit is limited in relying on the predominant conceptualization of autism as a stable clinical entity, rather than a temporally bound
neurodevelopmental phenomenon. In response to this epistemic limitation, this paper applies a temporal-neurodevelopmental perspective of autism, analyzing different hierarchical levels in the brain and function of concrete brain networks in relation with temporally bound motoric behaviors.

Methods:
This reflection on the ethics of early intervention of infants with the prodrome of autism draws on research around sensori-motor neurodevelopment and temporality in autism, as well as clinical data from early intervention with infants before the age of 18 months.

Results:
Three aspects of temporality associated with autism are highlighted in this paper.

  1. Autism as a neurodevelopmental condition unfolding in time;
  2. The observation of temporally bound motoric behaviors enables tracking the development of autism in infancy and response to early intervention.
  3. Relating hierarchical development of brain structure with experience of subjective time and embodied intersubjectivity.

Conclusions:
Three main conclusions arise from this theoretical reflection on the ethics of early intervention of infants with the prodrome of autism.

  1. The prodrome of autism is a temporally bound clinical entity assessed in terms of the development of distinct behavioral markers.
  2. Developing a full ethical framework for early intervention of infants with the prodrome of autism requires incorporating a temporal-neurodevelopmental perspective of autism including experience of subjective time consciousness.
  3. This temporal-neurodevelopmental perspective provides the means of navigating the tension between the therapeutic imperative for early intervention and epistemic uncertainty.