This
350-page book was really a disappointment to me. Not that the Diagnostic and
Statistical Manual  [DSM] itself is, in my opinion, the best we can
all do as clinicians, but we justify and allow it by saying that it gives us
the same language to communicate about our clients to either them, or other
treating doctors.

 For
instance, when you look at the criteria for autistic disorder in the DSM you
will see that a client needs two out of four, then one out of the next four,
and one out of the next four. Anyone who knows autistic children or adults knows
how artificial that feels. It really doesn ‘t say much about the exact criteria which will
then lead to exact treatment plans. And, frankly, it ‘s the last place I ‘d look to confirm the diagnosis.

 In
its section on autistic disorders, the DSM starts out with some general
information such as course, prevalence and a section on differential diagnosis.
Autism is differentiated from Rett ‘s Childhood Disintegrative Disorder, and
Asperger ‘s
Disorder. It is also differentiated from schizophrenia, selective mutism,
expressive language disorder, mixed receptive-expressive language disorder,
mental retardation and stereotypic movement disorder.

 When
I look up autism in Case Studies, however, it starts out with a case
study provided by one of the various case study providers — sources might include
university centers, the DSM-IV Task force and/or other experts. The case
discussed is that of a 15-year-old boy, which is very late for a diagnosis of
autism. These days, most are being diagnosed much earlier, while the brain is
still forming, so that treatment will be most effective. Unlike the DSM, this
book does discuss some treatment options. However, because treatment can be so
effective, if the authors chose to discuss treatment, this diagnosis is one that
deserves more than the brief mention it receives. Schools typically pay for
treatment even for preschoolers, and there is a known standard of care that if
used, can result in normal children. Just pick up any of the numerous books available
on the shelves in a bookstore and you will see how topical this discussion is
now. As for differential diagnosis, the same differential diagnoses for autism
are given in both books.

 Unfortunately,
because of the older age of the case study (15), the treatment planning section
was far less informative than the actual range available in the field, and the
available options for younger children. In only part of one paragraph, the
authors suggest that sustained educational and behavioral intervention is ”associated with improved outcome”. Many would argue
that if caught in time, such interventions absolutely result in improved
outcome.

 I’ve only chosen one
diagnosis to highlight the gist of the book. I had expected the book to add
something to my base knowledge, but it didn ‘t. The differential diagnoses are similar to
those already provided by the DSM, thus the point of the book for me is
useless. It might be useful for a beginning therapist, it’s a bit easier to
navigate than the DSM, but the information is the same. The only difference is
they provide case studies and small amounts of treatment information, but for
seasoned clinicians, neither of these is necessary.

© 2006 Patricia
Ferguson

Patricia
Ferguson, PsyD, is a licensed clinical psychologist as well as writer and
cofounder of an online magazine, Apollo’s Lyre (www.apollos-lyre.com). She has contributed to numerous books and
journals as well as medical and psychological journals and currently working on
a book based on her column in Apollo’s Lyre.  She and her husband and son live
in northern California.
  

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