Book Review: Making Sense of Autism Spectrum Disorders by James Coplan, MD

"Making Sense of Autistic Spectrum Disorders" by James Coplan MD is an impressive and enlightening piece of work. Among all the many books out there intended to introduce autism to parents, this is the only one I've seen that compares and contrasts treatments to show how they can be helpful at different stages of development. It's also the only book I've seen with a large section on prognosis - and it may well be the only book out there that describes the natural history of autism and how ordinary maturation and development can positively impact function.

Full disclosure: I do know Dr. Coplan, though I've met him only once in person. Dr. Coplan is a Philadelphia-based developmental pediatrician who is well-known within the Philadelphia autism community. He's also been kind enough to answer a few questions for this site, including:

• Best Intelligence Test for an Autistic Child
• Late Speech Can't Predict Autism Prognosis
• Will My Next Child Be Autistic?
• Will Autism Treatments Cure My Child?

I also had the pleasure of seeing an early draft of this book; the present version is a much stronger, more relevant publication than that early version.

This book isn't for parents brand new to autism. Yes, it's upbeat, and yes, it includes basic information about autism. But it's challenging, complex, and sometimes overwhelming. While reading this book, I found myself thinking "this is great stuff - but I can only take in a little at a time." It's just so rich in information - including diagrams, charts, photos and more - that it takes a while (and a basic understanding of the issues and controversies related to autism in today's world) to get through the whole thing.

This book isn't for parents interested in learning all about the Defeat Autism Now protocol for autism treatment, or for parents who believe strongly in the theory that autism is caused by vaccines. In fact, a whole chapter on "Sense and Nonsense in Autism Treatment" pretty much blows the DAN protocol out of the water.

This book is not a great reference for parents interested in learning all about special education, autism in the community, or other non-medical aspects of autism. While Dr. Coplan does include chapters on school and family life, both are relatively lightweight in comparison to the rest of the book. There are other, better references for those non-medical, non-treatment oriented topics.

This book is by far the most useful I've ever seen as a tool for understanding the history of autism spectrum disorders, the relationship between maturation and improvement of symptoms, prognosis for children with autism, and proper diagnosis of autism spectrum disorders. Dr. Coplan answers parent concerns about these issue with great care, explaining how intelligence and atypicality relate to prognosis, and how tough it can be to get an appropriate IQ measurement for a child with autism. He describes the evaluation process from a doctor's point of view, and is measured but optimistic in his tone.

For me, though, the most useful and significant part of this book is the section about behavioral and developmental treatments for autism. All too often, each separate treatment protocol - ABA, RDI, Floortime, etc. - is treated as an entirely separate and unrelated entity. But Coplan explains how they're the same and how they're different from one another. He also provides insight into why a particular treatment might be appropriate for a particular child, and why different treatments might be appropriate for the same child at different times in his life.

Coplan also provides solid descriptions of sensory integration therapy and its uses, and offers a long and full explanation of speech and language therapy. A chapter on "Communication First, Language Second," elucidates the importance of basic communication as opposed to simple acquisition of words. This chapter is particularly important for parents of non-verbal children who need the info to understand their children's needs.

As I've mentioned, there were certain bits of this book that made me stop, reflect, and even reassess what I thought I knew about autism and autism treatments. Here are a few such snippets:

"Picking the right therapy as your child moves along his path is like hitting a moving target; the answer to your question "What does my child need?" will change as your child makes progress." Most parents tend to pick a therapy and stick to it like glue; this statement (and the reams of helpful supporting information and examples) may change the way you think about therapeutic choices.

"ASD has a natural history of improvement over time, regardless of intervention." In other words, kids with autism will build skills and improve in functioning NO MATTER WHAT you provide in the way of therapy. This statement has huge implications: it's quite possible that a child's improvement over time is due, at least in part, to his own maturation process and NOT to the newest therapy you've added to the pot.

"The biggest differences between Natural Environment Training [a form of ABA], pivotal response treatment [a completely different form of ABA] and DIR [a developmental treatment also known as Floortime] are the vocabularies used by the different professionals involved....from the child's perspective, all of these programs look remarkably similar - regardless of the differing professional jargon." Living as I do in a world of violently competing philosophies, it's eye-opening to learn how similar these "very different" approaches can be!

As mentioned in the review, I know Dr. Coplan personally. He has contributed to this website. Please see the review itself for details.