Abstract
Increasingly, psychiatrists in practice are encountering individuals with autism spectrum disorders (ASD). According to the US Centers for Disease Control and Prevention, as many as 1 in 68 individuals has ASD (http://www.cdc.gov/ncbddd/autism/data.html). By adolescence and adulthood, many of these individuals will exhibit mental health or behavioural difficulties that can significantly affect them as well as their families.
It is essential that psychiatrists be familiar with common adolescent and adult issues and understand what the evidence tells us about intervention strategies. It is for this reason that psychiatrists may be interested in having a copy of this new book, published by Guilford Press.
This edited volume draws on the current literature and considers the full autism spectrum. Chapters are well written and cover a variety of relevant topics. The book contains chapters devoted to higher functioning individuals (previously described as having Asperger syndrome), and there is a key chapter on how ASD can affect the family. ASD interventions with the strongest evidence base focus on behaviour, so it is not surprising that 6 of the 14 chapters are devoted to this topic in adulthood (Section III), with clear clinical examples provided in each (positive behavioural supports, functional communication, sexuality, skill building, and leisure). Section II includes a chapter on transitioning out of school and a chapter on postsecondary education, which are critical issues for any adolescent with ASD and his or her family. (Some of the material in this section is for a US context, and although transition issues cut across jurisdictions, Canadian psychiatrists should be familiar with school and postsecondary options in their own province or territory.) The final section of the book focuses on employment, independence, aging, and estate planning and legal issues. This section contains some helpful references and ideas, but again it has a US focus. This is not helpful to Canadian psychiatrists when it comes to discussing guardianship, forensic issues, or policies related to the workplace. Indeed, almost all of the authors who contributed to this edited volume work in the United States.
The strengths of this book (its broad focus on education, employment, and behavioural skill development) are also its limitations. Given the frequency of health issues, particularly mental health issues in adolescence and adulthood, and the impact they can have on people with ASD and their families, I was quite surprised that no chapters were devoted to this topic. We do have a growing evidence base for interventions, both psychosocial and pharmacological, and we are aware of interventions for which evidence is lacking. Any psychiatrist supporting this population must know about the evidence base that pertains to supporting individuals with ASD and their families when mental health issues arise. There is a significant shortage of appropriate mental health services and of providers who feel competent working with the ASD population. This can lead to preventable and prolonged hospitalizations and dangerous polypharmacy, and it can lead to families in crisis, who sometimes give up the care of their adult child because of their complex and poorly supported situations. There is an emerging literature on successful psychological therapies for the individual and his or her parents, and medication studies are becoming more rigorous in nature. None of these topics were addressed in the book.
In summary, this book is a helpful introductory tool to many of the broad issues encountered by the adult ASD population and can serve as one of several resources for the psychiatrist focused on this group. It is very important that psychiatrists know how to teach communication strategies, manage sexuality issues, and promote skill development from a behavioural perspective. On its own, however, this book is not sufficient. What is needed in concert with this text are useful clinical tools for the psychiatrist as well as jurisdictional information on services, supports, and relevant policies.