Tuesday, August 18, 2009

Adults on the Autism Spectrum Leave the Nest: Achieving Supported Independence

From the very beginning of this book, I had mixed feelings about it. The author actually has a pretty good understanding of and background in disabilities and writes from that perspective. On the other hand, the author's understanding of autism is pretty thoroughly flawed. That said, however, the program talked about in the book was put together through emperical eclecticism (i.e. "do what works") and that has somewhat compensated for some, if not all, consequences of the author's lack of understanding.

Or, to put it another way, her heart's in the right place. This is surprisingly common when dealing with the clinical community.

This is also ironic given that one of case studies in the introduction was specifically selected for the purpose of illustrating the harm that misunderstanding a disability can cause. This case study is decidedly not the only one contained within the book which illustrates this problem. The author's selection of which case study to select to illustrate the problems which can arise when a disability is misunderstood is, in itself, a case study in the ways in which the author misunderstands autism.

This is not to say that the case study she selected -- that of a client who had multiple misunderstandings and encounters which, among other things, led to him being placed in "residential remedial care for boys with sexual deviancies of all kinds" (p. 22) and eventually being sexually exploited -- doesn't illustrate some of the problems that misunderstandings can cause. It's just that another of her selected case studies -- that of a girl whose parents misunderstood the nature of her disability and considerably underestimated her potential -- is far better as an illustration of this... even though the author selected it because it "typifies the newer practice, taking advantage of whatever help is available" (p. 15).

I'm also not trying to say that she's uneducated. The opposite is the case. She just misunderstands autism in the same ways that much of the clinical establishment does... which makes sense, given that she's getting her information from said clinical establishment.

She also tries to view autism from the perspective of a conceptual framework intended to handle injury- or illness-induced brain damage. To paraphrase Michelle Dawson, she likes to view autistic brains as broken versions of non-autistic brains despite the fact that this view of autism is not what the evidence supports.

I won't get into the construct validity of the book's description of executive functioning. I won't get into the issues associated with trying to teach autistics NT-style executive functioning skills and why I'm not surprised that such efforts often hit major roadblocks (for crying out loud, autistic people need autistic executive functioning skills!). I'm not even going to get into the various problems I noticed in the program the book details (most of which follow from the flawed understanding of autism it's based on).

I will, however, note that the program appears to have done some actual good... and is certainly a step in the right direction (i.e. it's better than full-out institutionalization and the situations many of the clients came from). I am, however, unaware of any peer-reviewed outcome study and the book only provides case studies as evidence.

A couple of other points:

  • Chapter 1 ("What Are Neurodivelopmental Disabilities?")... gyah! Overgeneralization based on a biased sample, much? I know you're working from your experience, lady, but you should have learned about sampling bias well before you got your Ph.D.! And, to boot, that's not the only problem with the chapter -- just the one which stands out the most.
  • The book writes off autistics who do not recieve early intervention. This is particularly interesting given the fact that one of the case studies is of a man who didn't recieve such intervention and who managed to hold a job for thirty years.
  • The continuous buy-in to the idea of adult autistics as physically grown-up "large children" is just plain offensive.

So, in short, this is basically a manual for a program that appears to be better than most institutions. That's not a bar that's terribly hard to reach... and it's lacking evidence on several critical elements that would determine whether or not it qualifies as an institution itself. I very much would not reccommend this book to the parents of an autistic child.

A clinician trying to design a program might find it interesting, though -- I'd just have to caution them that the program in question had more than its fair share of flaws and insure that they interpreted it through an appropriate framework.

Of course, I may have to revise my opinion in the future. One book, written by one of the people who designed the program, is hardly enough evidence to base a final judgement on. If I find something out about the program that isn't in the book (or that I missed during my read-through -- I did, admittedly, skim some sections), who knows what my opinion might change to?

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