Lisa Blakemore-Brown has written a
helpful and detailed book about children in the autism, aspergers, and
attention deficit hyperactivity spectrum of developmental disorders. These children may be very different from
one another, very much themselves, but share common impairments. They are unable to learn in the same way
most children learn and they are unable to take advantage of the richness of
their social and academic worlds. A
worthy idea, Blakemore-Brown proposes using the metaphor of weaving to describe
and promote thinking about the spectrum of disorders including autism,
aspergers, and ADHD. Perhaps what the
weaving metaphor speaks to is the need to individually tailor a comprehensive
intervention program for each child making an individual tapestry for that
child in the form of a treatment plan which details his or her particular
strengths and weaknesses. Other
well-known professionals in this area including Russell Barkley have endorsed
the idea that the three disorders may be better thought of as part of a broader
spectrum. Although not covering quite the same territory in terms of theory or
diagnostic spectrum, Rudolf Ekstein’s 1966 magnificently well-written Children
of Time and Space of Action and Impulse is a good read for those interested
in this general subject.

Blakemore-Brown has a private practice
conducting psychological assessments of children to diagnose autistic spectrum
disorders. Her examples of actual test reports are extremely helpful. Her
comprehensive evaluations contain developmental and social history for the
child being tested. Test results
include measures of academic achievement, 
IQ testing scales such as the Wechsler Intelligence Scales for Children,
and behavioral rating scales like the Conners Scales. She then provides a detailed conclusions section and a
comprehensive outline of the needed treatments for the child. Often these interventions involve parents,
schools and a variety of treating professionals like speech therapists,
occupational therapists, physical therapists, music or dance therapists,
counselors, doctors and life coaches.

Her book has detailed chapter
summaries in the introduction section so that readers can more easily find
specific information. Blakemore-Brown’s writing style is a bit stiff and overly
formal. She says her intent is “to provide a springboard from which families,
professionals and other interested individuals can examine some of these issues
and creatively explore how human development, and in particular the development
of positive social engagement with others and successfully planning and action
through life, in an interweaving dynamic process” (p. 15).

Her overarching metaphor of the
tapestry warp and weft, interbalancing and patterning speaks to the complexity
of the child within the autistic spectrum of disorders. Helping to make sense
of such a complex pattern may enable parents and treating professionals to
emerge from what seems like a tangled spider’s web of contradictions. She shows how the three disorders compare in
terms of levels of severity and symptom patterns, examining attributes like
social language skills, nonverbal cuing, motor skills and attention
skills. She compares the spectrum of
disorders with other difficulties like dyspraxia, Tourette’s, hydrocephalus,
and non-verbal disorders.

The first half of her book examines
antecedents to the disorders which can cause disturbances in normal
development. Some of these include metabolic problems, viral infection,
allergic reactions, and brain injury. 
She examines difficulties in several basic areas in a comprehensive way
emphasizing the need for consistent interventions. She says, “Weaving normal developmental tapestries requires the
careful execution of a plan and the weaving process involves repetitive,
rhythmic, and balanced actions as the story is developed” (p.34). She then examines difficulties with
reciprocity which in a severe exacerbation lead to children being unable to
understand or sympathize with the perspectives of others. She explains puzzling compensation mechanism
like obsessive thinking and compulsive repetitions.

Blakemore-Brown provides an
overview of diagnostic information and examines co-morbidity factors. She says that one must understand diagnosis in this area as referring to a cluster
of observed behavioral features often associated with biological causes but
this is a grey area and there are “interweaving features” (p. 104). Diagnostic categories of the DSM IV are, she
thinks, too rigid. She argues for a
“dimensional rather than a categorical approach” (p.122).

The last half of the book outlines
issues related to treatment interventions. 
She points out some of the failings of our current system, rather
passionately at times. Faults include
leaving diagnosis and treatment till the child is older out of a reluctance to
label the child, long waiting lists to get treatment, unwillingness of some
schools/institutions to work with outside specialists, cynicism, reluctance to
believe in the process, blaming the
parents and being overly brief and
informal in assessments. She sees the
need to untangle the system.

Some of the interventions she
suggests are identifying triggers, reducing stress, managing behavior, and
doing careful monitoring. She discusses
the use of modeling, imitation and transfer of learning. She lists the components of a successful
intervention: high family involvement,
intervention teaching, comprehensive language services, pragmatic behavioral
intervention, predictability of environment, and imitation training. She points out that not all things work or
every child. For example, some children
may need diet changes or home-based interventions while others may not. She also advocates the use of support
groups for parents like CHADD or NAS. She explains some of the promising and
effective treatments like the PECS or Picture Exchange Communication
System. The PECS uses a series if cards
which visually depict aspects of the child’s world. It is helpful with children who are primarily visual
learners. There is also Gray’s Comic
Strips for teaching social skills available from the Gray Center in Jenison,
MI.

Appendix 1 lists the criteria for
diagnosis of autism, aspergers and attention deficit hyperactivity disorder for
both the DSM-IV and the ICD 10 methods of classification. This may be especially helpful to parents
who may not have access to this information elsewhere. They can see exactly what caused a school or
treating professional to give their child a particular diagnosis.

Appendix 2 is a list of resources
for the UK, USA, and other world sites with helpline numbers or web page
addresses. Included are resources for
finding an ADHD coach, a growing new area of intervention. There is a listing of residential placement
centers for children who have problems so severe they cannot be treated on an
outpatient basis. There are listings
for the TEACH method developed by the University of North Carolina at Chapel
Hill, the Tomatis Method (a listening therapy), variations of the Lovaas Method
of behavioral intervention, The London Autism Project, the Son-Rise project for
home-based interventions, Auditory Integration Training (Ilford, Essex) and others.

©
2002 Marilyn Graves

Marilyn
Graves, Ph.D. is a clinical psychologist in private practice working with
children, adolescents and adults.

Categories: ChildhoodDisorders