I recently had the opportunity to review The Parent’s Guide to the Medical World of Autism by Dr. Edward Aull. Dr. Aull is a behavioral pediatrician who has been diagnosing and treating patients with autism spectrum disorders for more than 30 years.
Published in 2013 Dr. Aull acknowledged the new DSM-5 criteria but chose to continue using the DSM-IV terminology because he felt it was easier for families and many professionals to understand and follow. He does however create his own continuum, in which he discussed low, moderate, and high functioning autism as well as low, moderate, and high functioning Asperger’s syndrome. While this continuum may be helpful in Dr. Aull’s own practice, I’m not entirely sure the language will be useful for families who try to use the terminology with their own therapists and doctors which could lend itself to a great deal of frustration.
Dr. Aull clearly prefaces that his book is focused on medical intervention and in the foreword provides 5 tips for using medication as well as a 3 page glossary of terms. Having this information upfront is useful and honestly I wish more authors would consider being this upfront with terminology rather than burying it in the back of the book. Dr. Aull spends the introduction outlining his practice’s focus on autism, and ADHD along with their co-morbidities in patients ranging from preschoolers to young adults and identifying his own education background.
The book is divided into chapters on diagnosis, causes, evaluations, Autism, Asperger’s Syndrome, medications, atypical antipsychotic medications, ADHD, sleep issues, treatment examples, and tenets of treatment. The first 5 chapters provide few facts, no scientific support with the exception of a reference to a 2000 Science magazine article, and little information that would be new to a parent who has a child with an asd who is at the point of considering medication. One example of an unsupported statement can be found in chapter 2 when Dr. Aull states that he “often” sees depression, anxiety disorders, or obsessive-compulsive disorders in diagnosed children’s mothers. These chapters are however rich with anecdotal stories that provide examples of what the American Psychological Association outlines as language and social skill difficulties as well as restricted interests and sterotyped behaviors.
At times I find Dr. Aull’s statements to be frankly offensive to parents who are at this point in their autism spectrum research. For example on page 21 he states “Most patients are not going to get worse and in fact there will be improvement over time even if nothing is done. Some children do lose language and social interest. I cannot explain why this happens.” This seems to fly in the face of published research that shows early intervention is necessary and negates the experiences of parents whose children have faced regression. A discussion of families who live with someone who has autism being more insightful of seeing autistic behavioral symptoms in others led to his statement that “perhaps the best teacher for a child with an autistic spectrum disorder is a teacher who has a child on the spectrum.” While this statement may well be true, it doesn’t exactly provide information that a family can practically use. Speaking of information that a family can use, Dr. Aull does state that he has had several patients with Asperger’s syndrome go into military service. The causes for rejection for appointment, enlistment, and induction into military service include an entire class of mental health conditions including ADHD, history of perceptual difficulties, behavioral disorders, expressive or receptive language disorders, acute reaction to stress, anxiety, and obsessive compulsive behaviors among others leading one to question the accuracy of his claim.
Chapters 6, 7, 8, and 9 are what the book purports to be a parent’s guide for. The medications are well explained with stated generic and trade names as well as side effects, possible dosages, and how to introduce and/or increase the medications. As a parent though I want to see data that indicates these medications are safe; I want research beyond one doctor’s experiences particularly when discussing some incredibly powerful psychological medications, many of which are only fairly recently being used on children. Having said that, these chapters do provide parents with the terminology that may allow them to have more informed conversations with their own providers.
My other concern with Dr. Aull’s approach and discussion of medication is that if a parent fairly new in the process were to pick up his book and read it, they might walk away thinking that they can simply medicate away their child’s problems. Dr. Aull clearly outlines medications for anxiety, obsessive behaviors, sleep challenges, and mood disorders among other challenges faced by those with autism but he fails to mention that these medications need to be used in conjunction with some sort of other therapy programs. In fact he states on page 86 that he is “not saying that cognitive behavioral therapy shouldn’t be used with autism spectrum disorders; [only] that the results are usually less impressive.” Granted the book is focused on medical interventions but I think it is a dangerous oversight not to keep reminding readers that the medications alone aren’t treatment for autism.
Dr. Aull ends the book on a rather odd note. He provides “Dr. Aull’s Four Rules of Life” that all children should understand before reaching adulthood. First life isn’t always fair and second rank (seemingly referring to age) has its privileges. The third rule is that “he who has the gold makes the rules” which essentially ends any discussion between parents and children because parents always have the gold. Lastly “Women Remember” which Dr. Aull claims is the most important rule because it is something adolescent and adult males often complain about. With no discussion or explanation I’m not sure if the point of the book is that the right medication helps achieve these arbitrary rules laid out by Dr. Aull or if it was just another anecdotal point for readers to ponder.
I appreciated reading the stories that Dr. Aull has collected during his time as a behavioral pediatrician. The book has the potential to make interesting reading for a book club because individuals can see their own experiences in places throughout the book. At the same time over generalizations may leave some readers alienated such as the statement on page 53 that claims “typically, the student with an autism spectrum disorder lacks skills and interest in sports.” As a parent it is a book that I would skim in the bookstore to gather a list of commonly prescribed medications that I could then take home and do my own research on; it isn’t a book that I would be taking home with me though.
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