Abstract
Autism is a minefield. In a sense, the more one reads about it, the more difficult it is to interpret the huge expanse of fascinating yet often complex, divergent and conflicting literature on the condition, with perspectives from genetics, epidemiology, neuroscience, cognitive, behavioural and developmental psychology, to name but a few. The insight that autism offers for understanding typical and atypical development across each of these areas is remarkable, but it is also a somewhat baffling condition. Lack of clarity exists, in part, because there is no single explanation for its cause, and there is a vast diversity between individuals on the spectrum and in the manifestation of its symptoms. Numerous theoretical accounts offering potential explanations have been proposed, revised and refined over the last 50 years or so, yet a single or unifying account of autism remains elusive.
Practical issues can be equally as multifarious. While there are many independent, highly able and talented autistic individuals who bring a range of perspectives, skills and abilities to society, it can also be a debilitating and sometimes cruel condition. Other individuals may present with an array of incapacitating difficulties, severely challenging behaviours, and be dependent on others for even some of their most basic needs to be met. Getting a handle on the abundance of interventions that are available can feel overwhelming, with various unsubstantiated claims of “cures” and poorly conducted single case designs littered among carefully controlled double-blind randomised controlled trials (RCTs) with large groups with promising outcomes. Picking one’s way through this literature can be painstaking and precarious. What would be helpful—for academics, clinicians, practitioners, teachers, students, parents and carers alike—is a comprehensive yet succinct account of what we currently know regarding what autism is, what it’s caused by, and interventions and practical issues. Jill Boucher provides an elegant review and synthesis of these very issues, with a rounded look at what we know about autism from causal, diagnostic, theoretical and intervention perspectives.
I was excited at the opportunity to read this book, and it did not disappoint. Jill Boucher is rightly highly regarded as a leading expert on autism, and she is able to draw not only on her impressive academic career but also her clinical experience as a speech and language therapist. References to both are made via several insightful anecdotes which appear throughout the book. This revised (2nd) edition (first published in 2009) includes recent developments in research and practice and is written with greater weight on “practical issues,” and rather less on “causes” than the first edition. The book’s appeal is that it is multidisciplinary with an original perspective and is accessible to readers from a range of backgrounds. One does not need to have background knowledge of autism beforehand because key characteristics and definitions are laid out from the start, and there is also a glossary of terms. For the reader already acquainted with autism, Part 1 (“What is Autism?”) is nonetheless a valuable warm up before Boucher moves into her element in Part 2 (“What Causes Autism?”), offering a sophisticated yet accessible and concise discussion of explanations at the etiological, neurobiological and neuropsychological levels. Boucher provides an excellent synthesis of the interaction between genetics and the environment and an informative but succinct overview of brain bases, before pulling it all together in a superb discussion of explanatory theories at the behavioural level.
Part 3 covers practical issues, from assessment, diagnosis and screening, to intervention and care, where Boucher continues with a thoughtful, balanced and critical look at issues, from misuse of ASD diagnoses and the removal of Asperger’s Disorder from Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) to what is meant by outcome measures (should the focus be on “success” and achieving “normal” milestones, or maximising quality of life for each individual?). There is also a considered look at the neurodiversity movement and pros and cons of prevention, cure and treatment, further reflecting the contemporary nature of this revised edition.
Successfully written for a wide audience, the book highlights the complexity of autism without overwhelming the reader, and there are frequent referrals to recent key studies and review articles for readers wanting to know more. The book is clearly structured and laid out, and readers short of time have the option to skip to the summary sections at the end of each chapter of interest. A slight quibble is that it would have been helpful to have had more about clinical judgement and where this can deviate from DSM criteria in Part I (“What is Autism?”). I would also have liked to have seen more examples generally in this section, and perhaps again with the interventions.
Nevertheless, this is a great book for anyone who has an interest in autism and is looking for a critical synthesis of the literature across key areas. It has clear relevance for practitioners in various fields from education to clinical to social care to medicine, and the chapter on Assessment, Diagnosis and Screening is also important for policy makers. It would also be of relevance to interested parents, carers and family members of an autistic person who wish to know more from an informed source. I would also recommend this book for researchers: it gave me much food for thought and a fresh perspective in considering the wider bases and implications of behavioural processes that are the focus of my own research. What makes this book unique is that it so neatly synthesises the current state of understanding of the condition in an accessible format for those with no specialist knowledge on one hand, while also offering a great deal for autism researchers on the other. For anyone wanting an engaging, thoughtful and critical look at autism from a holistic perspective, by a world-leading expert on autism, I cannot recommend this book highly enough.
