Wednesday, May 06, 2015

The Autistic Brain by Temple Grandin (Book Review #38 of 2015)

The Autistic Brain: Thinking Across the Spectrum
I have an autistic son and try to read books easily accessible that deal with autism research and experiences. If someone asks me "What do I read to begin learning what autism is?" I will first suggest Simon Baron-Cohen's Autism and Asperger Syndrome: The Facts (my review) which was published in 2008. Cohen provides an overview of research on genetics, neuroscience, psychology, diet, and other areas and the Autism Research Centre at Cambridge houses most available research for the public. The Autistic Brain by Grandin (2013) is the second book I would recommend. It is similar to Baron-Cohen's work, but lengthier and includes Grandin's own anecdotal evidence from personal experiences, years spent interacting with others on the spectrum, and training as a biologist. It also highlights research more current than the other work. The reader also gets Grandin's wisdom on how to handle parenting or employing a person on the autism spectrum, as well as her opinions about certain research that is politically charged.

I had read both Grandin's The Way I See It and her biography by Sy Montgomery. These may well be prerequisites to understanding everything in The Autistic Brain. Grandin recounts the evolution of autism research from 1947 onward. She was quite fortunate to have a mother and a nanny who did activities with her similar to what behavioral therapists would do today (such as games focusing on turn-taking), and a family with resources to help her along the way (she penned this book at age 65). Grandin also examines brain research on how both autistics and neurotypicals see the world. Some are spatial thinkers while some see pictures. One set is better at algebra while the other is better at geometry, for example. As such, Grandin humbly repents of her earlier view that autistics all "see in pictures," as she does. It was the autism community pushing back on her previous work that led her to examine research more closely and change her mind.

Grandin's work has focused on accurate diagnoses and highlighting the strengths of autistics rather than the perceived weaknesses. She encourages parents to "avoid DSM labels," pointing out how the autism diagnosis has changed with each new DSM (DSM V was not finalized when this book was published, but the gist was already known). She's very critical of the DSM process, calling it "unscientific." Some parents have seen their child diagnosed with ADHD, then Aspergers, then Autism, and the route gets confusing and frustrating as diagnosis determines access to various services and insurance coverage.

Grandin notes that most ASD people have sensory disorders. She nicely summarizes the difference between each type and where they overlap (my son is a sensory-seeker, and his echolalia is symptom of an auditory processing problem as well). Unfortunately, there is actually little research being done on the sensory disorders themselves. In lieu of hard research, Grandin provides much anecdotal evidence from many autistic people, including some who have written other popular books. Music therapy is something many on the spectrum has found helpful. My own research into this has found more controversy than help (there are a wide range of "music therapy" scams), but in general I'd say "music is good."

Genetic causes get a great deal of research but genetics "aren't that simple" of an explanation. Diet, bacteria, and other environmental factors play a role and Grandin highlights researchers in these areas and what we know. She wades into the vaccination debate mainly to say that she believes parents who point to a clear time immediately post-vaccination where their children first showed signs of autism, sometimes severely. She is careful to phrase her words carefully, but points out new research into how an underlying mitochondrial could interact with a vaccination with side effects related to autism.

"Autism is in your brain," and there is a lot of research on brains, both from autopsies and neuroimaging. Various parts of the brains of people on the ASD are larger than the non-ASD population. Baron-Cohen also highlighted the research in his book, but Grandin updates it with what we know now. Grandin also highlights research into brain plasticity and what it means for those with autism or other challenges. There are a few tangents into the difference between spatial and image thinkers, fractal geometry, etc. that were a bit much. Grandin bemoans the education system that's been teaching mathematics the same way literally since Euclid-- algebra before geometry, for example. She recommends a host of free educational resources.

Grandin closes the book with a look at autism in the real world. What advice does she give to autistic parents and job-seekers? She reminds us that autism isn't what should ultimately define a person-- she is bothered by the people who introduce themselves to her by saying "I'm autistic," instead of "I'm an artist," "I'm a computer programmer," etc. She encourages parents to help children find their identity by getting them out of the house, out of routines, and into activities like part-time jobs. She gives a list of suggested occupations categorized by the type of thinker a person is. Word-fact thinkers (like my son) might do well in a sales job where they can utilize the wealth of information about a subject or object they have memorized, for example. The author advocates "teaching responsibility," reminding parents and autistic people: "Don't make excuses." She finds that many autistic people who have lost jobs simply weren't taught the basic social skills, like social thinking. Or they are like the daughter who could drive but had never been grocery shopping, her mom had always just bought groceries for her and she didn't learn that basic skill.

It's important to remember that an autistic person often doesn't hear the same things you do, and doesn't pick up on the same details most people do (I often forget this daily with my son). Grandin and other autistics typically have short-term working memory problems, although their long-term memory might be outstanding. This helps explain why my son has difficulty doing the same math problem he did two minutes prior, or that he's supposed to be tying his shoes, etc. It's not that he can't tell me who he was on the playground with him, he just didn't pick up on those details as important to remember.

While many see this as a weakness, Grandin writes it's important to remember and focus on the strengths that are the trade-off. My son can tell you every detail about how a combustion engine works from books he's memorized.

I enjoyed this book, particularly how Grandin draws on a wide body of research and also cites the experiences of people like John Elder Robison, whose autobiography I recently reviewed as well. I gleaned a few tidbits helpful to remember about my son and others I know on the spectrum. 4 stars. 

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