Journal of Developmental & Behavioral Pediatrics:
Children's Hospital Boston; Boston, MA
A Parent's Guide to Asperger Syndrome & High-Functioning Autism: How to Meet the Challenges and Help Your Child Thrive
by Sally Ozonoff, Geraldine Dawson and James McParland. New York
The Guilford Press, 2002, 276 pp., $18.95, paperback
This is an excellent resource for parents, providers and therapists of children with Asperger syndrome and high functioning autism. It is written in an easy, informal tone, with many examples making it accessible to both lay and professional audiences. The authors interweave empiric information with clinical vignettes and clear, explicit and detailed suggestions and strategies. Strategies draw heavily from behavioral theory and are presented in a highly practical and flexible manner. There is an appendix with resources grouped by topics, lists of newsletters, videos, websites and support groups and a detailed index.
The authors make the case that there is little data to distinguish Asperger's Disorder from Autism in high functioning individuals and they suggest the term Asperger's syndrome-High functioning Autism (AS-HFA). They acknowledge the confusion and controversy around diagnostic terminology among professionals and include advice to parents on focusing on understanding individual strengths and weaknesses. There is a discussion of the diagnostic terminology and an overview of the current knowledge about AS-HFA. Factors essential to an accurate diagnostic assessment are described including necessary time for interaction with the child and obtaining laboratory testing and psychological evaluation.
Causes for AS-HFA reviewed include what is known about brain differences, genetics and immunology in autism. The information presented is reasonable although the discussion of vaccines as a potential etiology for autism spectrum disorders could be stronger. There is a review of medical treatments and some controversial therapies of AS-HFA, acknowledging those treatments for which there is a lack of scientific data. Pros and cons of structured behavioral approaches such as applied behavior analysis (ABA) versus inclusion programming are also reviewed.
There is a focus on identifying and developing a child's strengths, making the case that a child with AS-HFA who has opportunities for success will be more adaptable and have higher self-esteem. Unique behaviors such as a desire for order, passion and conviction and compatibility with adults, which can become strengths with the right planning and support are discussed in this context.
Behavioral strategies and accommodations to be used in the home setting to target rigid behaviors and the need for structure and organization are well presented. There is a brief but helpful discussion of siblings and a review of school-based services including Individual Education Plans and 504 plans.
The chapter focusing on social skills interventions is particularly helpful for parents as these skills are the hardest to address in traditional school programs. A range of strategies including Social Stories, social skills training and peer coaching are described. The case is made that formal programming is particularly necessary in unstructured settings and suggestions for addressing social skills outside of school with specific examples that can be readily adapted by parents are given. The focus on older adolescents and young adults with AS-HFA in the final chapter has good advice on promoting social connections, disclosure of diagnosis and transitioning to adulthood and independence.
I think this is an excellent resource and I frequently recommend this book to parents. Much of the information on school programming and social skills interventions is useful to parents of children across the spectrum. The final chapter includes suggestions for accessing accommodations in college that would be useful for any student, including those with learning disabilities and ADHD.
Carolyn Bridgemohan, MD
Children's Hospital Boston