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For parents of children with autism spectrum disorders (ASDs) and even the professionals working with these children, the myriad of information available in books, journals and on the Internet regarding theories of etiology and treatment of these disorders can be overwhelming. Making Sense of Autism by Travis Thompson, PhD, is an attempt to consolidate current relevant, evidence-based information into a single text.
This text is written to be understood by families without eliminating any critical information regarding scientific aspects of these disorders such as neuroanatomy, physiology or biochemistry of common medications. Medical and educational jargon is used as appropriate. Rather than simplifying the information, the author explains difficult concepts in detail and provides an extensive glossary of technical, health and educational terms.
The book begins with explanations of the clinical signs and symptoms of ASDs, diagnostic criteria and differential diagnosis. It describes the subcategories of ASDs including autistic disorder, Asperger's syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS) as well as other developmental conditions that may resemble ASDs in certain characteristics. The primary brain dysfunctions that can explain some features of ASDs, as well as secondary dysfunctions that can result due to failure or non-use of the primary areas, are discussed as an introduction to the theory of neuroplasticity and rationale for early intervention.
With regard to families, basic recommendations and information about parental coping, choosing a doctor, selecting the most appropriate intervention for the child within the context of the family, selecting school placement and transitioning to a school environment are included. Of particular benefit to professionals working with children with ASDs is the chapter titled "Mental Health and Psychopharmacology in Autism Spectrum Disorders."
Many of these children are prescribed medications to address behavior issues, seizure disorders and anxiety or depression. This chapter explains the rationale for the prescription of drugs, their mechanisms of action and possible side effects, which may not be common knowledge to educators or therapists working with the children.
A good portion of the book focuses on early educational and behavioral approaches that have demonstrated some level of success with children with ASDs as supported by scientific research. Those specifically mentioned as having met these criteria include the Lovaas approach or Applied Behavior Analysis (ABA), Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACHH), the Denver Developmental Model and Intensive Early Behavior Therapy (IEBT). The role of speech therapy is discussed peripherally.
Dr. Thompson also describes alternative approaches that he states are not supported by evidence, either because of lack of testing or because research has failed to support the efficacy of the approaches. Among those he lists are sensory integration and auditory integration, which are used by some pediatric therapists.
Occupational therapists are included in the author's description of the core early-intervention team, with their role to address fine motor delays and "subtle perceptual-motor coordination problems" and provide desensitization to textures, tastes or specific tactile sensations. There is little mention of gross motor impairments in ASDs. Physical therapists are not named as part of the overall team, even in a consultative role, although adapted physical education is mentioned.
In summary, Making Sense of Autism is a comprehensive reference recommended for families of children with ASDs and the professionals who work with them. The text synthesizes a multitude of information gathered from various sources (with a thorough and diverse reference list) and the author's firsthand extensive experience.
Importantly, the text specifically warns families and practitioners to investigate the quality of evidence for particular treatments and therapies before wasting money, time and hope in pursuing them. For pediatric therapists, this is a convincing reminder of the need for clinical research and publication to prove the efficacy of our services, provide the best therapy to our patients as well as earn the respect and referrals of our professional colleagues.
Making Sense of Autism is a 280-page, soft-cover text priced at $29.95 and available from Paul H. Brookes Publishing Co. Inc., 800-638-3775 or www.brookespublishing.com
Laura Dobrich is a physical therapist at the Western Pennsylvania School for Blind Children in Pittsburgh, PA, as well as Children's Hospital of Pittsburgh.
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