Table of Contents

Cover

Title

Copyright

Dedication

Foreword

Preface

CHAPTER 1: What Is Autism?

AUTISM

ASPERGER’S DISORDER

CHILDHOOD DISINTEGRATIVE DISORDER

RETT’S DISORDER

PERVASIVE DEVELOPMENTAL DISORDER NOT OTHERWISE SPECIFIED

HOW COMMON ARE AUTISM AND RELATED CONDITIONS?

SUMMARY

CHAPTER 2: What Causes Autism?

GENETIC CAUSES OF AUTISM

SEIZURE DISORDERS AND ELECTROENCEPHALOGRAPHIC ABNORMALITIES

OTHER NEUROLOGICAL PROBLEMS

NEUROANATOMY AND BRAIN IMAGING STUDIES

NEUROCHEMISTRY

RISKS DURING PREGNANCY AND CHILDBIRTH

ENVIRONMENTAL CAUSES OF AUTISM

MEDICAL CONDITIONS AND AUTISM

PSYCHOLOGICAL MODELS OF AUTISM

UNDERSTANDING THE CAUSES OF PDDS OTHER THAN AUTISM

SUMMARY

CHAPTER 3: Getting a Diagnosis

FIRST CONCERNS

SCREENING AND INITIAL ASSESSMENTS

COMPREHENSIVE ASSESSMENTS FOR AUTISM AND RELATED CONDITIONS

AUTISM/ASD-SPECIFIC TESTS AND RATING SCALES

UNDERSTANDING THE RESULTS

PUTTING IT ALL TOGETHER

DIAGNOSTIC CERTAINTY AND UNCERTAINTY

WHAT HAPPENS AFTER THE ASSESSMENT?

SUMMARY

CHAPTER 4: Getting Services

THE INDIVIDUALS WITH DISABILITIES EDUCATION ACT (IDEA)

KEY CONCEPTS AND PROVISIONS OF IDEA

YOUNG CHILDREN: SPECIAL CONSIDERATIONS

DISCIPLINARY ISSUES

THE IEP—PROCESS AND CONTENT

PRIVATE SERVICES

DEALING WITH INSURANCE

SUMMARY

CHAPTER 5: An Overview of Educational Programs

MODEL PROGRAMS

SPECIAL EDUCATIONAL NEEDS OF THE CHILD WITH AN ASD

MAINSTREAMING

STUDENTS WITH ASPERGER’S

TRANSLATING WHAT WE KNOW TO SCHOOL PROGRAMS

SUMMARY

CHAPTER 6: Educational Interventions

AUTISM-FOCUSED CURRICULA

SOCIAL SKILLS INTERVENTIONS

LANGUAGE AND COMMUNICATION PROGRAMS

ORGANIZATIONAL ISSUES/SUPPORTIVE TECHNOLOGY

ADAPTIVE SKILLS AND GENERALIZATION

SUMMARY

CHAPTER 7: Working With Young Children

SIGNS OF AUTISM BEFORE I YEAR OF AGE

SIGNS OF AUTISM BETWEEN 12 AND 36 MONTHS

ASPERGER’S AND PDD-NOS

SCREENING FOR AUTISM—FIRST STEPS IN GETTING A DIAGNOSIS AND SERVICE

ACCESS TO SERVICES FOR VERY YOUNG CHILDREN

CASE REPORTS

SUMMARY

CHAPTER 8: Working With School-Aged Children

DEVELOPMENT AND BEHAVIOR

SENSORY AND BEHAVIORAL ISSUES

GENDER DIFFERENCES

SCHOOL-RELATED ISSUES

MAINSTREAM ING AND PEER PREPARATION

CASE STUDIES

SUMMARY

CHAPTER 9: Adolescence, Adulthood, and the Future

ADOLESCENCE: BASIC FACTS

ADOLESCENCE IN CHILDREN WITH ASDS

BEHAVIOR PROBLEMS IN ADOLESCENCE

SEXUALITY

HIGH SCHOOL: CHALLENGES AND OPPORTUNITIES

TRANSITION TO COLLEGE OR VOCATIONAL PROGRAM/SCHOOL

HYGIENEAND SELF-CARE SKILLS

MOVING TO ADULTHOOD

VOCATIONAL ISSUES

LIVING ARRANGEMENTS FOR ADULTS

PLANNING FOR THE FUTURE

LEGAL PROBLEMS FOR ADULTS

PSYCHIATRIC COMORBIDITIES IN ADULTS

CASE REPORTS

SUMMARY

CHAPTER 10: Managing Medical Issues and Problems

CHALLENGES IN PROVIDING HEALTH CARE FOR CHILDREN WITH AUTISM

HELPING MEDICAL VISITS BE SUCCESSFUL

OTHER MEMBERS OF THE HEALTH CARE TEAM

MEDICAL CONDITIONS MORE COMMON IN AUTISM AND RELATED DISORDERS

COPING WITH COMMON MEDICAL PROBLEMS

EATING PROBLEMS

COPING WITH THE EMERGENCY DEPARTMENT AND THE HOSPITAL

COPING WITH THE HOSPITAL

DENTAL CARE

IMMUNIZATIONS AND AUTISM

SUMMARY

CHAPTER 11: Ensuring Safety

GENERAL HOUSEHOLD SAFETY

SAFETY AT SCHOOL

COMMUNITY SAFETY

SUMMARY

CHAPTER 12: Dealing With Seizures

WHAT IS A SEIZURE?

How COMMON ARE SEIZURES?

TYPES OF SEIZURES

EVALUATING A SEIZURE DISORDER

OBSERVING A SEIZURE

TREATMENT OF SEIZURES

CONTINUING CARE AND SAFETY CONCERNS

WHAT CAUSES SEIZURES?

SUMMARY

CHAPTER 13: Dealing With Regression

REGRESSION IN AUTISM

CHILDHOOD DISINTEGRATIVE DISORDER(CDD)

RETT’S DISORDER

SUMMARY

CHAPTER 14: Dealing With Behavior Problems

BEHAVIORAL INTERVENTIONS—A BRIEF INTRODUCTION

DRUG INTERVENTIONS—A BRIEF DISCUSSION

TYPES OF BEHAVIORAL AND EMOTIONAL DIFFICULTIES

ATTENTION AND OVERACTIVITY

MENTAL HEALTH ISSUES AND BEHAVIOR PROBLEMS

CASE EXAMPLES

SUMMARY

CHAPTER 15: Considering Medications for Behavior Problems

MENTAL HEALTH ISSUES IN AUTISM

WHEN TO USE A MEDICATION

MEDICATIONS USED IN AUTISM AND RELATED CONDITIONS

SUMMARY

CHAPTER 16: Managing Sensory Issues

SENSORY DIFFERENCES IN AUTISM

EATING AND FEEDING ISSUES

HEARING PROBLEMS

VISUAL PROBLEMS

OTHER SENSORY PROBLEMS

ASSESSMENT OF SENSORY DIFFICULTIES

SOLUTIONS FOR OTHER SENSORY PROBLEMS

SUMMARY

CHAPTER 17: Managing Sleep and Sleep Problems

TYPICAL SLEEP PATTERNS

SLEEP IN AUTISM

DEALING WITH SLEEP PROBLEMS—SOME GENERAL ADVICE

DEALING WITH SPECIFIC SLEEP PROBLEMS

MEDICAL ISSUES AND MEDICATIONS

SUMMARY

CHAPTER 18: Considering Complementary and Alternative Treatments

UNDERSTANDING HOW SCIENCE WORKS

MEDIA AND THE INTERNETAS SOURCES OF INFORMATION

THINKING ABOUT COMPLEMENTARY AND ALTERNATIVE TREATMENTS

COMPLEMENTARY AND ALTERNATIVE TREATMENTS FOR CHILDREN WITH AUTISM

DRUG TREATMENTS AND MEDICAL PROCEDURES

COMMUNICATION AND AUDITORY INTERVENTIONS

OTHER COMPLEMENTARY AND ALTERNATIVE APPROACHES

SUMMARY

CHAPTER 19: Managing Sibling and Family Issues

STRESSES AND SUPPORTS

SUPPORT FROM EDUCATORS AND OTHERS

AGE-RELATED STRESSES

MARITAL ISSUES

SINGLE-PARENT FAMILIES AND DIVORCE

GRANDPARENTS AND FAMILY MEMBERS

TALKING WITH FRIENDS

SIBLINGS

FAMILY ENGAGEMENT, GENERALIZATION, AND LIFE IN THE COMMUNITY

SUMMARY

Resources Lists: Books and Websites

WEBSITES

STATE-SPECIFIC RESOURCES

BOOK AND JOURNAL PUBLISHERS AND VENDORS WITH MAJOR AUTISM AND AUTISM SPECTRUM LISTINGS

APPENDIX 1: Diagnostic Descriptions and Criteria for Autism and Related Pervasive Developmental Disorders from International Classification of Diseases, 10th Edition (World Health Organization, Geneva, Switzerland, 2003; Reprinted with Permission)

Glossary

Index

End User License Agreement

List of Tables

CHAPTER 1: What Is Autism?

TABLE 1.1 DIFFERENTIAL DIAGNOSTIC FEATURES OF AUTISM AND NONAUTISTIC PERVASIVE DEVELOPMENTAL DISORDERS

CHAPTER 3: Getting a Diagnosis

TABLE 3.1 WARNING SIGNS OF AUTISM IN THE FIRST AND SECOND YEARS OF LIFE

TABLE 3.2 FREQUENTLY USED SCREENING INSTRUMENTS FOR AUTISM

TABLE 3.3 SELECTED TESTS OF INTELLIGENCE/DEVELOPMENT

TABLE 3.4 COMMONLY USED TESTS OF SPEECH–LANGUAGE–COMMUNICATION

TABLE 3.5 DIAGNOSTIC TESTS/INSTRUMENTS FOR AUTISM

TABLE 3.6 DIAGNOSTIC TESTS/INSTRUMENTS FOR ASPERGER’S

TABLE 3.7 MOTOR AND SENSORY MOTOR TESTS

CHAPTER 5: An Overview of Educational Programs

TABLE 5.1 FEATURES OF COMPREHENSIVE PROGRAMS

TABLE 5.2 INTERACTION OF INSTRUCTIONAL STRATEGIES AND CURRICULUM AREAS

CHAPTER 6: Educational Interventions

TABLE 6.1 SOURCES OF INFORMATION AND CURRICULA FOR STUDENTS WITH AUTISM

TABLE 6.2 USES OF PIVOTAL RESPONSE TRAINING

TABLE 6.3 CHALLENGES FOR ENHANCING SOCIAL COMMUNICATION ABILITIES AT VARIOUS DEVELOPMENTAL LEVELS

TABLE 6.4 EXAMPLES OF MILIEU TEACHING METHODS

TABLE 6.5 AUGMENTATIVE ALTERNATIVE COMMUNICATION STRATEGIES: AN OVERVIEW

CHAPTER 7: Working With Young Children

TABLE 7.1 SYMPTOMS OF AUTISM IN THE FIRST YEAR OF LIFE

TABLE 7.2 SYMPTOMS OF AUTISM: AGES 1 TO 3 YEARS

CHAPTER 9: Adolescence, Adulthood, and the Future

TABLE 9.1 STAGES OF PUBERTY (TANNER)

CHAPTER 12: Dealing With Seizures

TABLE 12.1 COMMON TYPES OF SEIZURES

CHAPTER 13: Dealing With Regression

TABLE 13.1 REGRESSION IN AUTISM SPECTRUM DISORDER–SUBTYPES

TABLE 13.2 MEDICAL CONDITIONS CAUSING DETERIORATION

TABLE 13.3 CLINICAL FEATURES OF CHILDHOOD DISINTEGRATIVE DISORDER

TABLE 13.4 STAGES OF RETT’S DISORDER

CHAPTER 15: Considering Medications for Behavior Problems

TABLE 15.1 SELECTED SECOND-GENERATION (ATYPICAL ANTIPSYCHOTICS)

TABLE 15.2 SELECTED FIRST-GENERATION ANTIPSYCHOTIC MEDICATIONS

TABLE 15.3 SELECTED MEDICATIONS FOR TREATMENT OF ADHD

TABLE 15.4 SELECTED ANTIDEPRESSANTS AND SEROTONIN REUPTAKE INHIBITOR MEDICATIONS

TABLE 15.5 SELECTED MOOD STABILIZERS

TABLE 15.6 SELECTED ANTIANXIETY MEDICATIONS

CHAPTER 18: Considering Complementary and Alternative Treatments

TABLE 18.1 THE SCIENTIFIC METHOD

TABLE 18.2 COMPLEMENTARY AND ALTERNATIVE DIETARY/NUTRITIONAL TREATMENTS IN AUTISM-AN OVERVIEW

List of Illustrations

CHAPTER 1: What Is Autism?

FIGURE 1.1 “Bim gets breakfast in the love kitchen.” Drawing by a child with autism. Bim is the child’s made-up cartoon character. We thank the child and his parents for permission to reproduce. Reprinted, with permission, from F. Volkmar and D. Pauls, Autism. The Lancet, 2362, 1134, 2003. Reprinted with permission.

FIGURE 1.2 Autobiographical statement and drawing of area of special interest, 10-year-old boy with Asperger’s disorder.

FIGURE 1.3 Stereotypic hand movements in Rett’s syndrome

CHAPTER 2: What Causes Autism?

FIGURE 2.1 Rates of first seizure in samples of individuals with autism

FIGURE 2.2 Visual focus of an autistic man and a normal comparison subject showing a film clip of a conversation.

FIGURE 2.3 Percent viewing time spent focused on mouth, eye, object, and body regions in viewers with autism and typically developing persons.

CHAPTER 6: Educational Interventions

FIGURE 6.1 Conversation Symbols

CHAPTER 7: Working With Young Children

FIGURE 7.1 Age of onset. Cases with clinical diagnosis of autism from DSM-IV Field Trial.

FIGURE 7.2 Eye gaze pattern in a 2-year-old with autism. This image, generated using infrared eye tracking shows the unusual gaze of a toddler with autism. Rather than looking at any of the characters in the scene, the child focuses on what, to most toddlers (and adults), would be irrelevant details.

FIGURE 7.3 Assessment results for Bob at age 22-months (results expressed in age equivalents). Results from the Mullen Scales of Early Learning. VR = visual reception (nonverbal problem-solving), FM = fine motor, GM = gross motor, RE = receptive language, EX = expressive language; results from the Vineland Adaptive Behavior Scales for PL = play, and IP = interpersonal.

FIGURE 7.4 Age-equivalent scores on the Mullen Scales of Early Learning achieved by Helen.

FIGURE 7.5 Age-equivalent scores on the Vineland achieved by Helen.

CHAPTER 9: Adolescence, Adulthood, and the Future

FIGURE 9.1 Outcome Results: 5 Studies 1956-1974

FIGURE 9.2 Outcome Results: 5 Studies 1989-2003

FIGURE 9.3 Vineland Adaptive Behavior Scores

CHAPTER 12: Dealing With Seizures

FIGURE 12.1 Rates of first seizure in two samples of individuals with autism (Volkmar & Nelson, 1990; Deykin & Mac-Mahon, 1979) and a normal British sample (Cooper, 1975).

FIGURE 12.2 Seizure types in autism.

CHAPTER 13: Dealing With Regression

FIGURE 13.1 Onset of CDD and autism. Age of onset in 160 cases with clinical diagnoses of CDD and 316 cases with clinical diagnoses of autism.

CHAPTER 14: Dealing With Behavior Problems

FIGURE 14.1 Behavioral data from Willy, a boy with “bolting.” Data are presented for consecutive school days; and ** indicate changes in behavior procedures. See text for explanation.

CHAPTER 18: Considering Complementary and Alternative Treatments

FIGURE 18.1 Mark Twain

Guide

Cover

Table of Contents

Begin Reading

Pages

cover

contents

iii

iv

v

ix

x

xi

xii

xiii

xiv

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

181

182

183

184

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

201

202

203

204

205

206

207

208

209

210

211

212

213

214

215

216

217

218

219

220

221

222

223

224

225

226

227

228

229

230

231

232

233

234

235

236

237

238

239

240

241

242

243

244

245

246

247

248

249

250

251

252

253

254

255

256

257

258

259

260

261

262

263

264

265

266

267

268

269

270

271

272

273

274

275

276

277

278

279

280

281

282

283

284

285

286

287

288

289

290

291

292

293

294

295

296

297

298

299

300

301

302

303

304

305

306

307

308

309

310

311

312

313

314

315

316

317

318

319

320

321

322

323

324

325

326

327

328

329

330

331

332

333

334

335

336

337

338

339

340

341

342

343

344

345

346

347

348

349

350

351

352

353

354

355

356

357

358

359

360

361

362

363

364

365

366

367

368

369

370

371

372

373

374

375

376

377

378

379

380

381

382

383

384

385

386

387

388

389

390

391

392

393

394

395

396

397

398

399

400

401

402

403

404

405

406

407

408

409

410

411

412

413

414

415

416

417

418

419

420

421

422

423

424

425

426

427

428

429

430

431

432

433

434

435

436

437

438

439

440

441

442

443

444

445

446

447

448

449

450

451

452

453

454

455

456

457

458

459

460

461

462

463

464

465

466

467

468

469

470

471

472

473

474

475

476

477

478

479

480

481

482

483

484

485

486

487

488

489

490

491

492

493

494

495

496

497

498

499

500

501

502

503

504

505

506

507

508

509

510

511

512

513

514

515

516

517

518

519

520

521

522

523

524

525

526

527

528

529

530

531

532

533

534

535

536

537

538

539

540

541

542

543

544

545

546

547

548

549

550

551

552

553

554

555

556

557

558

559

560

561

562

563

564

565

566

567

568

569

570

571

572

573

574

575

576

577

578

579

580

581

582

583

584

585

586

587

588

589

590

591

592

593

594

595

596

597

598

599

600

601

602

603

604

605

606

607

608

609

610

A Practical Guide to Autism

What Every Parent, Family Member, and Teacher Needs to Know

Fred R. Volkmar

Lisa A. Wiesner

Copyright © 2009 by John Wiley & Sons, Inc. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008.

Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering professional services. If legal, accounting, medical, psychological or any other expert assistance is required, the services of a competent professional person should be sought.

Designations used by companies to distinguish their products are often claimed as trademarks. In all instances where John Wiley & Sons, Inc. is aware of a claim, the product names appear in initial capital or all capital letters. Readers, however, should contact the appropriate companies for more complete information regarding trademarks and registration.

For general information on our other products and services please contact our Customer Care Department within the U.S. at (800) 762-2974, outside the United States at (317) 572-3993 or fax (317) 572-4002.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our website at www.wiley.com.

Library of Congress Cataloging-in-Publication Data

Volkmar, Fred R.
A practical guide to autism : what every parent, family member, and teacher needs to know / By Fred R. Volkmar, Lisa A. Wiesner.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-470-39473-1 (pbk.)
1. Autism. I. Wiesner, Lisa A. II. Title.
RC553.A88V65 2009
616.85’ 88200835—dc22
2009021153

To Lucy and Emily,
who have taught us about being parents
and to the many children and their parents
who have taught us about being doctors

Foreword

Autism is in the public spotlight now more than ever as new research and information appears almost daily. Although in many ways this is a positive development it also presents challenges to families and practitioners who want to keep up with the latest developments and are left to sift through new information by themselves to see what is credible and relevant for them. Each of us needs a personal research assistant who can determine which information we need to pay attention to and let us know how it might affect our daily work and the children we are living with or serve.

Since we each don’t have our own research assistants on staff, I am delighted to recommend this wonderful book by Fred Volkmar and Lisa Wiesner. Both of these talented professional leaders have combined their scientific skills and understanding of the field with great practical experience and ideas about how research can be translated into clinical practice. The result is a book that provides the best and most comprehensive information about recent scientific developments and a splendid practical guide for how they are being implemented and what we are learning in the process. The issues are presented in all of their complexity but translated into language that is clear, direct, and easy to follow. The format also lends itself to understanding the complex issues and their implications through excellent charts, question and answer sections, and chapters that vary from describing diagnostic issues to stating very specifically how to expand and evaluate the services one is receiving. The comprehensive references and lists of additional resources also add greatly to the overall package.

As a professional dedicated to understanding scientific advances and helping families and teachers to utilize them most effectively, I am very pleased to have an ally like this book available. I am very grateful to the authors for providing a very credible, practical, and relevant addition to our field to help the many advocates and family practitioners to better understand the exciting new developments and how they can be implemented in our day to day work. Those taking the time to read through this superb volume will find it time well spent that pays back dividends in many different ways.

Gary B. Mesibov, Ph.D.
Professor and Director of TEACCH
Treatment and Education of Autistic and Related Communication
Handicapped Children
University of North Carolina at Chapel Hill

Preface

We have written this book to provide parents and teachers with information that we hope will help them get the best possible care for their child or the children under their care. The two of us approach this from slightly different perspectives. One of us, Fred Volkmar, is a child psychiatrist whose main area of clinical work and research is in autism. The other, Lisa Wiesner, is a pediatrician who has seen children with autism and other disabilities in her pediatric practice. In addition to bringing our professional perspectives to the book, the two of us are married and parents of two children. We hope that this book will provide parents and teachers of individuals with autism and related disorders some practical and useful information.

Our aim is to provide an understandable guide to what we feel are the most important things for parents and teachers to know. We try, as much as possible, to refer readers to relevant materials—both books, chapters, and research papers. We have tried, as much as we can, to stick with resources that are readily available and written in ways that parents as well as professionals can understand. It is, in some ways, gratifying to be able to say that we are by no means exhaustive in this regard. There are many excellent resources not included here, although we’ve tried to give a reasonable sample of the best things available.

We have tried to think very broadly about the kinds of information that parents and teachers need to know. Accordingly, we have chapters focused on a wide range of topics. Given our interest in the medical as well as behavioral and educational aspects of autism, we’ve included chapters on medical issues, safety, and medications, as well as what would be the more usual chapters in a book of this kind.

We are very much aware that, for parents, the rewards of raising a child with an autism spectrum disorder are just as great as for any other parents. However, the challenges can be more daunting because parents have to take the child’s difficulties into account in almost all decisions made about his or her education and health care. This book reviews basic information about autism and related conditions and how these disorders are diagnosed and treated. Keep in mind that in this book we are trying to provide important general information that will help parents and teachers provide good care. This book can’t (and won’t) Substitute for having a good working relationship with the various professionals who can advise you about what is best for your child in particular. The information provided in this book should supplement but does not replace the need for the child and family to have an ongoing relationship with educators, health and mental health care providers, and legal professionals who know the child and specifics of the situation very well. Laws, for example, can vary significantly from state to state, and this knowledge may be important as parents and others think about long-term planning. Similarly, keep in mind that while we’ve made every effort to be accurate and up to date, knowledge changes over time, and with the increasing amount of research on autism, the pace of change has quickened considerably.

Over the past decade there have been important advances in understanding the syndrome and in treating its symptoms. We know now that we can recognize and reduce the negative effects of these conditions on the child’s development and behavior. In considering any intervention, it is always important to weigh the risk against the possible benefit of the intervention. As the saying goes, “The perfect is sometimes the enemy of the good.” That is, sometimes it is better not to strive for perfection but for reasonable care and quality of life. As discussed in this book, many new treatments for autism also periodically become available. Sometimes these are well evaluated scientifically. Unfortunately, much of the time they are not. In a later chapter in this book, we will review some of these treatments and discuss how parents and teachers can make informed decisions about using them.

In each chapter we include questions from parents and our answers. We hope that these are a helpful way for you to learn from the experience of others. Throughout the book, we also include some tables and boxed material with additional information. The final sections of the book include a glossary as well as a list of additional resources. A reading list is included at the end of every chapter. Again, remember that in reading this or any book, it is important to interpret the information with the specific child in mind. In this effort, various professionals can be important allies.

We are grateful to a number of our colleagues who have reviewed parts of this book in our efforts to make it helpful to parents. We have profited from their wisdom and comments. They include, in alphabetical order: Karyn Bailey, Leah Booth, Rebecca Carman, Kasia Chawarska, Mark Durand, Tina Goldsmith, Debbie Hilibrand, Ami Klin, Kathy Koenig, Andrés Martin, Prisca Marvin, Nancy Moss, Rhea Paul, Michael Powers, Brian Reichow, Terrell Reichow, Penn Rhodeen, Celine Saulnier, Larry Scahill, Alison Singer, Tristam Smith, Kathy Tsatsanis, and Sally Zanger. We also thank our various colleagues who kindly allowed us to reprint, sometimes with modifications, materials from other sources, particularly the Handbook of Autism. Gary Mesibov merits special thanks for his willingness to contribute a foreword. We also are grateful to our editor, Patricia Rossi, and the staff at Wiley for their unflagging support and help in making this book as parent friendly as possible. We also thank a dedicated staff of professionals who helped us assemble the final copy—Lori Klein and Rosemary Serra, and, in particular, Emily Deegan, who went above and beyond the call of duty in coping with the many demands of producing this book. Finally, we thank our children, who have taught us much about child development, and, of course, our patients and their families, who have taught us much about autism.

Fred Volkmar, MD
Lisa Wiesner, MD

CHAPTER 1
What Is Autism?

This chapter gives some background on autism and related autism spectrum disorders (ASDs). The recognition of autism as a disorder is a relatively recent one, first described in 1943 but not “officially” used as a diagnosis until 1980. Other conditions such as Asperger’s disorder were “officially” recognized even more recently. In this chapter we discuss these disorders and how our understanding of them has changed over the years. This is important for several reasons. One is that you may hear many different terms used to describe a child’s difficulties. Second, because knowledge has changed over the years, there are some misconceptions about autism that you may encounter (particularly among people who haven’t kept up with the field!). Finally, if you are looking at this book, you are probably wondering if a child you know has autism. We think it would be helpful for you to know something about autism!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!

Lesen Sie weiter in der vollständigen Ausgabe!