Between “Cautious Optimism” and “Cautious Pessimism”: Clinicians’ Strategies for Delivering News about Autism to Families

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Abstract

Once considered a rare disorder, today autism is estimated to affect 1 in 59 U.S. children. As more children are evaluated for autism, clinicians across the country routinely face the task of informing parents that their child has the condition. By the same token, however, they also rule out autism more often. In this paper, we investigate how clinicians deliver the news that a child does, or does not, have autism to its parents. We show that, in cases where the child qualifies for the diagnosis, clinicians are cautiously optimistic, encouraging parents to see the condition as treatable through early intervention. However, when autism is ruled out, parents do not necessarily react with relief, since the absence of diagnosis can create symptom residue and anxiety about finding the right services for the child. Accordingly, with these parents, clinicians often display what we term cautious pessimism – they emphasize that while the child doesn’t have autism, it’s likely that s/he does have another psychiatric condition. In so doing, they reassure parents that the child’s problem is doctorable – and, by implication, that the parents’ concerns are legitimate, and that the child’s difficulties aren’t their fault. Finally, we document a variation on the cautious optimism that clinicians display toward young autistic children – when the child is older, the clinicians treat autism as a unique and valuable way of perceiving the world, rather than something to be “cured.” In this way, our findings complicate debates between medical practitioners and activist groups over the propriety of treating autism as a disease to be cured – in practice, clinicians alternately display both orientations toward the condition, depending on the local identities of news-recipients.

Authors

• Jason Turowetz, University of Siegen

• Douglas W. Maynard, University of Wisconsin