From our regular book review column.
Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment, and Treatment
Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment, and Treatment
Like Dorothy in The Wizard of Oz famously said, "Toto, I’ ve a feeling we’ re not in Kansas any more," this excellent book alerts clinicians to the fact that the autism landscape isn’ t what it used to be. The book’s editors, Chawarska et al, from the Yale Child Study Center, are among the most qualified professionals to assemble a volume on this topic for practitioners. The book’s 12 chapters are authored by many notable clinical and educational researchers.
The first half of the book explores assessment and diagnosis, with 1 chapter each discussing developmental (Wetherby and Woods) and naturalistic behavioral (Koegel et al) approaches to early intervention. Smith and Wick examine "controversial treatments," and one chapter discusses medical issues, such as epilepsy, gastrointestinal problems, and genetics (Volkmar et al). One chapter is devoted to sensory motor research and theory (Baranek et al).
The book is intended for practitioners, and most chapters avoid technical jargon, but in some instances it is difficult to discuss concepts (eg, genetics) without the use of appropriate terminology. The chapter by Volkmar et al, "Autism Spectrum Disorders in Infants and Toddlers: An Introduction," is especially noteworthy, as is the outstanding chapter by Bishop et al on "Diagnostic Assessment." Rhea Paul’s well-written chapter, "Communication Development and Assessment," might have been strengthened by more emphasis on the relation to intervention.
One change in the autism landscape is the emphasis on integrated behavior therapy and developmental interventions. Early interventionists in autism have a penchant for bickering, so the 2 chapters on those topics are refreshingly free of squabbling. Wetherby and Woods do an excellent job of laying out the principles of a developmental approach to early intervention and point out similarities with more recently developed behavior therapies, such as "Naturalistic Behavioral Approaches to Treatment," discussed by Koegel et al. The book minimally discusses evidence reviewed by the National Research Council in 20011 and more recent journal article reviews2,3 regarding the efficacy of various comprehensive autism early-intervention approaches, clearly favoring structured intensive behavior therapy.
An important contribution of the book is that it disabuses the reader of the notion that autism is a monolithic disorder. The editors argue that there are autisms that differ widely in their 3 core symptoms, as well as have distinct developmental trajectories. The editors wisely argue for a dimensional approach to different forms of autism. Klin et al illustrate unpredictability of the developmental path for some children with autism and discuss likely reasons for the observed differences.
In their chapter, "Medical Issues," Volkmar et al point out that there are multiple genetic causes as well as other events that can disrupt early morphogenesis4 causally linked to autism. An important paper by Morrow et al5 appeared in Science shortly after this book was published, showing that several autism genes expressed in brain, play a critical role in synaptogenesis and are activity-dependent; those genes appear to be responsible for early acquisition of typical skills as a consequence of intensive early intervention in autism or emergence of symptoms in their absence.
The status of regression and sensory-motor integration in autism remain elusive to this reader. The book’s editors make a compelling case (in "Autism Spectrum Disorders in Infants and Toddlers: An Introduction") that true regression (ie, significant loss of skills) is quite rare in autism. In other chapters throughout the book, various other authors suggest contrariwise that regression (ie, loss of skills) in autism is common, a belief shared by many parents.
In their "Controversial Treatments" chapter, Smith and Wick discuss the fact that there is very limited evidence supporting sensory-motor therapies, sensory integration therapy, and auditory integration therapy, while Banarek et al devote a chapter specifically to such issues in autism, which some readers may find puzzling. Many of these same issues were examined, as well, in the last chapter ("Caveat Emptor") of my book, Making Sense of Autism.6 [Editor’s Note: Making Sense of Autism, by Travis Thompson, was reviewed in this column of the November 2008 issue of the Journal.]
This is an outstanding book for practitioners involved in evaluating, treating, or providing other services to young children with autism spectrum disorders who need an up-to-date summary of a rapidly changing scientific landscape.
References
1. Lord CE, McGee JP. Educating Children With Autism. National Research Council. Washington, DC: National Academies Press; 2001.
2. Eikeseth S. Outcome of comprehensive psycho-educational interventions for young children with autism. Res Dev Disabil. 2009;30(1):
158-178. PubMed doi:10.1016/j.ridd.2008.02.003
3. Reichow B, Wolery M. Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA young autism project model. J Autism Dev Disord. 2009;
39(1):23-41. PubMed doi:10.1007/s10803-008-0596-0
4. Miles JH, Takahashi TN, Bagby S, et al. Essential versus complex autism: definition of fundamental prognostic subtypes. Am J Med Genet A. 2005;135(2):171-180. PubMed
5. Morrow EM, Yoo SY, Flavell SW, et al. Identifying autism loci and genes by tracing recent shared ancestry. Science. 2008;321(5886):218-223. PubMed doi:10.1126/science.1157657
6. Thompson T. Making Sense of Autism. Baltimore, MD: Paul H. Brookes Publishing Company; 2007.
Author affiliation: Departments of Psychology and Special Education Program, University of Minnesota Medical School, Minneapolis. Financial disclosure: None reported.
doi:10.4088/JCP.09bk05251
© Copyright 2009 Physicians Postgraduate Press, Inc.
