Making Sense of Autistic Spectrum Disorders: Create the Brightest Future for Your Child with the Best Treatment Options - Hardcover

Coplan, James

 
9780553806816: Making Sense of Autistic Spectrum Disorders: Create the Brightest Future for Your Child with the Best Treatment Options
Hardcover
ISBN 10: 0553806815 ISBN 13: 9780553806816
Verlag: BANTAM DELL, 2010

Inhaltsangabe

In this authoritative and empowering book, one of the world’s leading experts on early child development gives caregivers of children on the autistic spectrum the knowledge they need to navigate the complex maze of symptoms, diagnoses, tests, and treatment options that await them.

For more than thirty years, James Coplan, M.D., has been helping families cope with the challenges posed by autistic spectrum disorders (ASD). Each family that walks into his office, he knows, is about to begin a journey. With this book, he lays out the steps of that journey. Dr. Coplan brings you into the treatment rooms and along for the tests and evaluations, and provides the kind of practical hands-on guidance that will help you help your child with ASD through every phase of life.

At a time when ASD has become the subject of wild theories and uninformed speculation, Dr. Coplan grounds his recommendations in reality. He helps you understand for yourself where your child may be on the spectrum that includes autism, Asperger Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified. His clear, comprehensive, and compassionate advice prepares you to make informed medical decisions, evaluate the various educational and therapeutic alternatives, and find answers to such fundamental questions as

• How do I optimize my child’s long-term potential?
• Which interventions will best serve my child?
• How do the various therapies work, and what is the evidence to support them?
• What is the best way to teach my child?

This book empowers you to be an expert advocate for your child, so that you’ll know when to say no to an ill-advised therapy or medication and can make with confidence the hundreds of important decisions you will face in the years ahead. For every parent who has made the painful transition from “Why did this happen?” to “What can we do to help our child?,” here is the indispensable guidebook you’ve been waiting for.

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Über die Autorin bzw. den Autor

James Coplan, M.D., is one of the few physicians in the world to be board-certified in both developmental-behavioral pediatrics and neurodevelopmental disabilities. Trained at New York Medical College and the Johns Hopkins University, for eighteen years he directed resident training in child development at Upstate Medical Center in Syracuse, New York, followed by an appointment as director of interdisciplinary training in developmental disabilities at The Children s Hospital of Philadelphia. Now in private practice in Rosemont, Pennsylvania, he specializes in the care of children with ASD. He continues to teach at the University of Pennsylvania and is a frequent speaker at the local and national level.

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Chapter One

Patterns of Development

Our child is off the beaten path. —Parents of a child with autistic spectrum disorder

Three Young Friends

I’d like you to meet three youngsters who can help illustrate the many facets of autistic spectrum disorder (ASD). I’ve referred to these children as friends, not because they know one another (they are all fictionalized, composite versions of patients of mine, as are all the patients mentioned in this book), but because the children whom I evaluate eventually come to regard me as their friend. The best way to get a child to reveal himself or herself to me, and to work with me, is to befriend the child. Sometimes this means getting down on the floor and playing with the child (I’m always wearing out the knees of my slacks). Sometimes it means letting the child explore the train memorabilia in my office, or letting him or her play with various sensory toys I keep stashed away (a battery-operated spinner, blinking rubber balls, etc.). And at all times it means respecting children and accepting them for who they are, even as I may try to reshape their behavior into more adaptive patterns.

You’ll meet these three children as I did, when their parents brought them to me, and perhaps you’ll get a sense of how a developmental pediatrician approaches the process of assessing a child, getting to know the family, and determining the next steps. In later chapters we’ll come back to these three children, to see how their stories have progressed. As you will see, all three of these children are boys. Males outnumber females with ASD about three to one. There are plenty of girls in this book, but for these three examples I’ve kept the gender the same, in order to avoid confusing severity with gender- related issues.

Kevin, Age Thirty-Three Months

This visit starts like so many others. “Kevin has delayed speech” is the first thing Kevin’s parents tell me. “He jabbers like he’s speaking a foreign language. We think he understands us when we say no, but he usually doesn’t listen to us when we speak to him or ask him to do things. He tunes us out. For a while we thought he might be deaf, but the audiologist said his hearing is fine. He manages to get his point across by pulling us where he wants us to go, and then putting our hand on what he wants.”

“Is there anything else that worries you?” I ask.

“He has this weird fascination with people’s earlobes. Whenever we hold him, all he wants to do is stroke our earlobes. And he is the master of routines. At bedtime, we have to do things exactly the same way each night, or he flips out.”

“What does he do for play?”

“He loves his beads-on-a-wire toy. That can keep him busy for hours. Or flipping through the pages of a book—not really looking at the story, just flipping the pages. Or rolling one of his toy cars back and forth and watching the wheels go around. When he gets really excited, he spins himself around, or walks on his toes. He does like to be tickled or be chased by his dad around the room as a game. But otherwise he’d rather sit by himself and play with the beads.”

Just these first few snippets of conversation with his parents have me concerned. They’ve already mentioned several warning signs of ASD: rigid, repetitive behavior; fascination with spinning objects; limited play skills; odd physical mannerisms; and across-the-board language delay.

As for his other skills, Kevin’s parents report that he is finger- feeding (a seven-month skill) but still not using a spoon, a critical milestone that he should have reached eighteen months ago. When I ask what Kevin does with crayons, they immediately reply, “Oh, we can’t give him crayons! He would just eat them.” Toddlers normally transition from using a crayon as a teething object to using it as a writing implement around twelve to fourteen months of age, the same age at which they learn to use a spoon. Kevin’s delayed use of the spoon and crayon as tools worries me. ASD alone would not account for this deficit, raising the possibility of global cognitive delay, and an eventual diagnosis of mental retardation.

On examination, Kevin makes virtually no eye contact, and his vocalization is limited to crying. He follows no verbal commands with or without gestural cues from me (such as putting out my hand while saying “Give me . . .”), and he doesn’t copy me when I build with blocks or draw with a crayon. He is not being uncooperative. Rather, he is unaware of me or my intentions. He’s cut off from others, incapable of being either cooperative or uncooperative.

On the other hand, Kevin interacts directly with the test materials as long as he isn’t required to observe or copy another person. We call this stimulus-driven behavior. In other words, the physical aspects of the item itself “drive” the child’s behavior; it’s almost as if the shapes “want” to go into the holes, or the bell “wants” to be rung. The child responds directly to the object without any need to relate to the adult. This is normal in a seven-month-old shaking a rattle or a sixteen-month-old fitting shapes into a shape sorter. By Kevin’s age, however, a child’s behavior and use of objects should be much more attuned to social cues, and the functional use of an object— driving a train, feeding a doll, looking at a book, or imitating a grown-up—rather than merely interacting with an object at the level of its physical properties. Preschool children with ASD generally do well on stimulus-driven tasks but stumble when they have to take cues from another person. I’ve seen many children with ASD complete complex shape-matching tasks such as puzzles, yet fail on the simplest imitative task, such as stacking two blocks. It’s not that the child doesn’t know how to stack; the missing link is the child’s inability to appreciate that he or she is expected to imitate an action modeled by the adult. Kevin successfully completes the pegboard task (designed for children of fourteen to sixteen months), but it’s strictly between him and the pegboard. Rather than looking up for approval after completing the task, he twirls one of the pegs in front of his eyes. Based on Kevin’s developmental history, my observations, and the results of standardized tests, I diagnose Kevin with autism. Based on the history of delayed adaptive skills (not using a spoon as a tool, for example), I also diagnose developmental delay.

Darryl, Age Twenty Months

“We’re worried because he doesn’t speak,” Darryl’s mother begins, “He babbles and says ‘mama,’ but sometimes he says ‘mama’ because he’s distressed or uncomfortable, not just to mean me.” Delayed speech in early childhood is the concern or symptom I hear about most often from parents. However, I’m interested in comprehension as well as speech. I want to know if Darryl recognizes his own name. (Typically, infants respond selectively to their own name at around nine months.) “I think so,” Darryl’s mother says, “although sometimes he acts as if he doesn’t hear us.”

I ask more questions. Does he follow simple commands, like “Come here” or “Give me . . .”? Children typically start following commands at about twelve months, but Darryl’s mom tells me he started doing so only a month before the visit. I make a mental note that his receptive language may be delayed, along with his speech. Does he play gesture games, like patty-cake or peek-a-boo?...

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Verlag
BANTAM DELL
Erscheinungsdatum
2010
Sprache
Englisch
ISBN 10 
0553806815
ISBN 13 
9780553806816
Einband
Gebundene Ausgabe
Auflage
1
Anzahl der Seiten
424
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Verantwortliche Person
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