Book Review

Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment, and Treatment

N Engl J Med 2008; 359:1300-1301September 18, 2008

Article

Autism Spectrum Disorders in Infants and Toddlers: Diagnosis, Assessment, and Treatment
Edited by Katarzyna Chawarska, Ami Klin, and Fred R. Volkmar. 348 pp. New York, Guilford Press, 2008. $42. ISBN: 978-1-59385-649-6

The earliest symptoms of autism spectrum disorders often appear before a child's second birthday, but most children with autism are not diagnosed until they are in preschool or elementary school. If they could be diagnosed earlier, they could be treated earlier and perhaps — as the editors and authors of this book believe — their symptoms in adulthood would be less severe. An earlier diagnosis could also allow better observation and follow-up of the child's development and a better understanding of the individual autistic child and of autism in general. Drawing from a vast source of literature, the book begins with a meticulous summary of what is now known about the symptomology of autism spectrum disorders in the first, second, and third years of life.

Subsequent chapters present the different methods that can be used to make a comprehensive assessment of the cognitive and adaptive skills of the very young child, the goal being to understand the child's level of functioning in verbal and nonverbal recognition as well as the extent of the child's sensory motor and communication skills. Assessment of the developmental history as told by the parents is an important factor, as 25 to 30% of children with autism spectrum disorders have some loss of skills between the ages of 18 months and 24 months. This statistic emphasizes the importance of early recognition and treatment.

Chapter 6 reports three interesting case studies of autistic infants who were first evaluated in the second year of life. These children, given the pseudonyms Helen, Nick, and John, received occupational and physical therapy as well as speech and language services. These case studies show that the outcome can differ from what was expected given the variability of individual progression. The authors discuss the popular notion among many researchers that there is not one autism but many different autisms, as both the phenotype and genotype can vary so much. The cause is likely to be multifactorial and complex, yet a common pathway of assessment and treatment remains valid because in all cases the development of social and communication skills is disrupted. The authors emphasize the importance of evidence-based intervention for young children with autism spectrum disorders, with a focus on the core deficits associated with autism, as well as a family-centered approach, keeping children in their home environments if possible. The authors also discuss current models of early, naturalistic behavioral approaches and common forms of treatment that are controversial.

This comprehensive book on autism spectrum disorders is rich in information. It is an important step toward the goal of designing interventions that target the mechanisms that underlie the symptoms.

Rita Enahoro, Ph.D.
Stichting De Jutters, 2566 ER The Hague, the Netherlands