As a therapist I often see how difficult an autism spectrum diagnosis can be. On the lower-functioning end of the spectrum (autism), there are language, developmental, and social delays that make the first few years of life quite hard for both the person on the spectrum and her family.
Some young children on the low-functioning end don’t develop language, or develop it at a slower pace than other kids the same age. For individuals who are at the higher-functioning end (Asperger’s or PDD-NOS), life is still difficult, but in a different way. Social interactions and interpersonal relationships can be extremely challenging and limited. It is a struggle to keep relationships vibrant and interesting, to share passions and find pleasure in joining with others, and to connect with others using small talk or friendly conversation. Things like metaphors, complex examples, abstract thinking, and jokes prove perplexing to most higher-functioning individuals.
In A Parent’s Guide to High-Functioning Autism Spectrum Disorder: How to Meet the Challenges and Help Your Child Thrive, Sally Ozonoff, Geraldine Dawson, and James C. McPartland introduce the topic of high-functioning autism by providing multiple case examples and scenarios. The book answers questions that parents may have about their child, provides updated information on diagnosis and treatment challenges, and gives the reader resources for school, therapy, and family support. And — especially important for families of higher-functioning children — the authors offer great insight on the often-confusing diagnostic process.
It is already difficult for families to experience and cope with the social, interpersonal, emotional, and behavioral challenges that come with a high-functioning autism spectrum disorder, but even more difficult for parents when they seek help and are told that their child could or could not have autism — that it’s unclear.
The diagnostic process is not an exact science, and misdiagnosis is likely. In book’s second chapter, the authors list a number of diagnoses that are often mistaken for high-functioning autism, including intellectual disability (previously known as MR – mental retardation), ADHD, obsessive-compulsive disorder, oppositional defiant disorder, reactive attachment disorder, schizoid personality disorder, selective mutism, social anxiety, and speech-language disorders.
It is also important to mention here that many children and adolescents who struggle with ADHD, who exhibit behaviors common to oppositional defiant disorder, or who show signs of social anxiety disorder can also meet criteria for a pervasive developmental disorder or high-functioning autism spectrum disorder diagnosis. I have seen families who find it difficult to recognize that their child, already diagnosed with oppositional defiant disorder or ADHD, could have an autism spectrum disorder on top of it. And mental health professionals have a challenging time, too, identifying traits of a PDD-NOS diagnosis or autism spectrum diagnosis.
Then, once a parent receives a diagnosis of high-functioning autism spectrum disorder or PDD-NOS, stress begins to mount. They must now find school-based services, community activities, and mental health services that will be covered by insurance, supported by the school district, and affordable. Parents must also adjust the child’s daily schedule, learn how to appease the child who is resistant to change, and provide support for the child to succeed.
In chapter seven, Ozonoff, Dawson, and McPartland help parents process what services are best for their personal situation and what is typically available in their community. The chapter addresses common issues such as deciding between schools, understanding IEPs, requesting classroom accommodations, and learning about TSS or BSC services. It is an especially useful resource to parents struggling with education-related difficulties. And in addition to school issues, the authors give guidance in other chapters on how to support social development, how to engage with a child with high-functioning autism, and how to use therapeutic tools.
In fact, the best thing about this book is that it takes the reader through all of the developmental stages parents will encounter and provides comprehensive information along the way. Whereas many other books offer information for specific ages, this is a more complete resource.
Having worked with children on the low-functioning and high-functioning ends of the spectrum, I have researched thousands of books on the topic. This is an especially useful book — full of information that both clinicians and families can use.
A Parent’s Guide to High-Functioning Autism Spectrum Disorder: How to Meet the Challenges and Help Your Child Thrive
The Guilford Press, November 2014
Paperback, 308 pages