Social & Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, & Intervention

This book is edited by two world-renowned authorities in the autism field and contains powerful contributions from various experts in the field of autism spectrum. What I most like about this book is the new information presented in a matter-of-fact manner that looks simplistic in style but with profound meaning. It is a clinician friendly book and starts with the clinician’s difficulties regarding children with autism spectrum disorders (ASD). That focus is maintained throughout the eleven chapters (divided into four parts), even when researchers are explaining their lab-based observations of, let us say, imitation studies. A clinician’s first impulse is to find out how to accurately appraise a clinical problem, and the editors seem to have sensed it. The first part opens with an overview of assessment and diagnosis. Especially appealing is the discussion on early diagnosis of children with ASD. The second concern most clinicians express is regarding how serious the problem of screening is in their community, and part two of this book does full justice in addressing this concern. There is a scholarly discussion on screening for ASD in populations, and an extremely informative chapter by Wendy Stone, one of the editors, on the early screening for ASD in clinical practice setting. What readers get from these two aspects of screening for ASD, in populations and in clinical settings, is that we are far from making robust diagnostic predictions based on available screening tools, as all these instruments have limitations in the sensitivity and specificity. A similar situation exists for the second level of screening for ASD where the challenge is mainly to translate these screening instruments from research setting to community settings. Part III describes “evidence-based interventions.” In chapter five, authors Yoder and McDuffie inform us of the intricacies in understanding joint attention. The definition of joint attention is clarified for readers, followed by critical examination of programs and their ability to enhance the joint attention process. Authors suggest potential predictors that will determine the response to joint attention treatments in children with autism. These predictors are described as the degree of social interest, awareness or interest in language, and play level or degree of preservative object use (page 138). The next chapter gives an authoritative description of three approaches for language development in young children with autism. These include the didactic behavioral approach, the naturalistic behavioral approach, and the developmental language approach. I found that the questions raised by the author (Sally Rogers) were very helpful in understanding the current controversies over merits and advantages of several language based interventions used in ASD treatment options. Questions raised have immense practical applications. For example, should all nonverbal children with autism be taught an alternative communication system even when there is no evidence base? For parents trained in giving didactic teaching or naturalistic behavioral language training, should they also receive ongoing individual training? Chapter seven takes readers to the intricacies of designing quality peer play interventions for children diagnosed with ASD. The authors describe the Integrated Play Groups (IPG) model in detail and how children with ASD benefit from play based interventions by improving their social interactions and communication. I found the next chapter interesting for several reasons. It describes the use of imitation as a basis for intervention approach in children with ASD. First, it did not try to simplify the very complex process of imitation, but expands the potential of immediate imitation. Second, it explains how a three-step procedure set to examine imitation can distinguish children with autism. Third, the chapter elaborates that children with autism display spontaneous imitation and that often it is correlated with the developmental age than a chronological age. This chapter was not an easy read. The chapter on alternative communication system is particularly well written. It resonates the clinician’s frustrations when many interventions are given to children with ASD without a known evidence base. Use of signing, picture communication systems, picture exchange communication systems, social stories, written communication, computerized systems and facilitated communication are described as alternatives to enhance communication. Furthermore there is a lengthy description on how functional communication training (different from facilitated training) can help us understand the appropriateness of seemingly mal-adaptive behaviors. Multiple communication systems approach is the combination of several interventions that may involve signing and other symbols. The studies using this approach did not show generalization to untrained settings, and maintenance required adult prompting. There is a helpful table about assessing the alternative communication strategy on the merits of the characteristics of the system. The factors to look for are the portability, speed, permanence, whether it could easily shape the desired goal, phrases possible, iconicity, reciprocity, and demands on other’s understanding. Moreover, child skills such as motor skills and cooperative attitude in executing alternative communication also were emphasized. Part IV describes the developmental and neurobiological issues involved in early social communication. This part could have constituted a mini book in itself. Somehow, this part seemed to stand on its own, with little connection with the other chapters. I wonder if this information, so vital in understanding autism, should not have been placed in the first chapter. There is an extremely eloquent description of the neural substrates of Initiating Joint Attention (IJA) and Responding to Joint Attention (RJA). Whereas the RJA are related to the “social brain circuit” (page 303), IJA are associated with the dorsomedial frontal cortex and the anterior cingulate. IJA therefore have an association with the anterior attention system. Interestingly, the authors (Mundy and Thorp) ask a crucial question that most of us would ask, “What is the clinical application of this research?” The authors conclude that even if there are no clear cut answers, this process of linking neurobiology in understanding clinical phenomena at least raises good testable hypotheses. Some of these hypotheses discussed were the learning processes in children with autism and connections with IJA and functions of dorsomedial frontal brain and anterior cingulate. The second hypothesis is about what kind of behavioral interventions would best address the development of IJA and RJA? The authors suggest that RJA type of interventions are relatively easy to institute and may be sensitive to external rewards, which is not the case for IJA where internal motivation and executive constraints are important. This part gives up-to-date information on the neurobiological processes written in a clinician-friendly manner. I did get lost in many abbreviations in chapter 11 — imagine, IJA, RJA, STS, STG, BA, ESCS and so on. This book is well referenced. It provides up-to-date information on the social and communicative development in autism spectrum disorders. It is however, not a basic reading on the subject. Clinicians who are providing interventions that target the social and communication deficits in ASD will find this book useful, and therefore, is applicable to the practice of psychologists, psychiatrists, speech and language therapists and educators. This is a type of book that needs to be reread in order to grasp all of the compacted information. At the same time, one would not re-read it with a grudge.

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