Table of Contents

Acknowledgements. Preface. Why this book. Plan of the book. Stigma. Biological vs. experiential. Limits. Introduction. Future enlargement of the ASDs. The challenge of the ASDs for all mental health professionals. Challenge, and opportunity. Coverage of the book. The brain and developmental disorders. ADHD. Swedenborg's hypothesis. Could some kinds of ASD be purely psychogenic? Emotional isolation caused by ASD. Can experience sculpt the brain? Epigenesis and learning. The limits of neuroimaging. How clinically useful is a study of the brain? Networks. Emergent properties. Neurodiversity. Other social considerations. Scope and plan of part 2. Part 1. Sciences basic to ASD. Chapter 1. Neurology of the superficial structures of the brain. Right hemisphere. Anatomy. Normal function. Functional effect of lesions in adulthood. Functional effect of lesions in childhood. Structural and functional changes in the ASDs. Parietal cortex. Inferior parietal lobule. Temporal cortex. Anatomy. Normal function. Structural and functional changes in the ADHD and the ASDs. Temporoparietal junction/ parietal operculum. Frontal and prefrontal cortex. Prefrontal cortex. Chapter 2. The cerebellum, and deep structures in the fore-brain. Cerebellum. Anatomy. Function. Functional effect of lesions in animals. Functional effect of lesions in childhood. Structural and functional changes in the ASDs and related conditions. Amygdalae. Anatomy. Function. Functional effect of lesions in animals. Functional effect of lesions in adulthood. Functional effect of lesions in childhood. Structure and function in the ASDs. Cingulate. Anatomy. Function. Functional effect of lesions in adulthood. Structural and functional changes in the ASDs. Insula. Anatomy. Function. Functional effect of lesions in adulthood. Structural and functional changes in the ASDs. Fusiform gyrus. Anatomy. Function. Functional effect of lesions in adulthood. Structural and functional changes in the ASDs. Chapter 3. Interactions in genes and neurons. Single nucleotide polymorphisms. Copy number variants. Haplo-sufficiency. Imprinting and expression. Epigenetic variation. Tandem repeats. Where we are now. Local area networks: minicolumns. Anatomy. Normal function. Working memory networks. Functional networks and fibre tracts. Anatomy. Normal function. Functional effect of lesions in childhood. Functional effect of lesions in adulthood. Structural and functional changes in the ASDs. Functional aggregates, modules, or systems. The default network. Normal anatomy. Normal function. Functional impairment in default network in ASD and ADHD. The anti-correlated, task focussed network. Attention disorders and the anti-correlated networks. Functional disorders of anti-correlated networks and the ASDs. Chapter 4. Developmental, social and emotional considerations. Social factors. In determining whether or not there is a disorder. Advantages to society in ASD and ADHD. Socioeconomic factors and ASD. Ethnic factors and ASD. Social factors affecting the symptom profile of ASD. Social dominance, power and authority. Anger, aggression, and violence. Social factors affecting the quality of life of people with ASD. Cultural factors. The construction of deviant identities. Cultural explanations of the causes of ASD. Normalization. Deviancy theory. Adopting a pathological identity. Acquiring an identity. Family interaction. Chapter 5. Social orientation, communication, and language. Social orientation. Eye orientation. Gaze following. Inference from gaze or movement direction. Imitation. Relevance to ASD. Chunking. Relevance to ASD. Communication. Classical approaches to communication. Linguistics. Digital communication. Design features of a language. The medium and the message. Combinatorial approaches to communication. Two fundamental types of communication. Anatomical approaches to communication. Language, speech, and writing. Anatomy. Development. Normal function. Impairment: speech and language disorder. Developmental speech and language disorder. Articulation disorders. Speech dyspraxia ('phonological disorder'). Phonological disorders. Speech reading and writing impairment (dyslexia). Relation to ASD. Receptive language disorders ('specific language impairment'). Prevalence of types of speech and language disorders. Management of speech and language disorders. Chapter 6. Nonverbal communication, empathy and theory of mind. Nonverbal communication. Are all nonverbal communication channels affected in ASD? Orienting attention, salience and interpersonal communication. Recognition of emotional expression. Empathy. Affective empathy. Emotional contagion. Emotional contagion and ASD. Emotional contagion and affective empathy. Self-recognition. Self and other judgements in ASD. Modulating affective empathy. Cognitive empathy. Theory of mind. When theory of mind and empathy conflict. Empathy has to be merited. Empathy modulation. Implications for ASD. Chapter 7. Neuropsychology of ASD. Introduction. Intelligence. Testing. Relation to ASD. Memory. Testing. Relation to ASD. Executive function. Relation to ASD. Working memory. Inhibition of prepotent responses. Attention shifting and attentional maintenance. Repetition and pursuit of sameness: tics, stereotypies, obsessions and compulsions. Motor coordination and topographical orientation. Ataxia. Dystonias and dyskinesias. Dyspraxia. Topographical disorientation. Part 2. Clinical aspects of ASD. Chapter 8. The autistic syndrome. Case history. Differentiating developmental disorder and mental illness. Diagnostic criteria. Setting the scene. Historical preoccupation with language. Practically useful criteria for ASD. External validity of an ASD diagnosis. Autistic syndrome. Dimensions of disorder in ASD. Early recognition of the autistic syndrome. Screening for the autistic syndrome. Red flags. Is screening currently worthwhile? Surveillance. Differential diagnosis. Investigation. Chapter 9. Presentation, prevalence, treatment, and course of the autism spectrum disorders. Presenting symptoms of the ASDs. Attention deficit hyperactivity disorder. Language impairment. Prevalence. Rates of ASD. Rates of specific AS sub-types. Rates of ADHD. Rates in different age groups. Gender differences in rates. Has there been an increase in prevalence? Treatment. Diagnosis. Information. Training. Early intervention. Focussed remediation. Psychoeducation. Dealing with anxiety. Enablement. Sensory integration. Medication. Other interventions that are mentioned in later chapters. Course. False assumptions about course. Social disability does not affect quality of life. Quality of life in people with ASD and their carers. Burden. Conclusions . Chapter 10. Clinical assessment of the ASDs. The goal of clinical assessment. Guidelines. Who makes the diagnosis? The setting for the diagnosis. History taking. Developmental history. Other aspects of family history taking. Structured observation and examination. Nonverbal expression. Nonverbal interpretation. Speech and language. Assessing co-morbidity, associated conditions, social responses, and personal reactions. Prosocial competence. Cognitive style. Specific developmental syndromes. Temperament. Assessment of co-morbid disorder. Psychiatric disorder in the context of ASD. Intellectual disability. Family or relationship factors. Physical assessment. Sleep problems. Impact on sleep of co-morbid disorders. Chapter 11. Aetiology of the autism spectrum disorders. Introduction. Factors present at conception. Biological sex. Heritability. Genetic causes of ASD. Intra-uterine factors. Maternal stress. Placental insufficiency. Hormones and brain development. Infections. Teratology. Perinatal factors. Neonatal jaundice. Postnatal factors. Psychological events. Postnatal conditions having a recognized predilection for the brain. Chapter 12. Presentation in infancy and early childhood (the pre-school years). Relevant developmental challenges. First suspicions of ASD. Red flags. Diagnostic criteria. Illustrative case history. Presenting symptoms. Primary handicap. Secondary impairments. Tertiary disability. Differential diagnosis and associated conditions. Speech and language disorder. Hyperlexia. Attachment disorder. Distinction from intellectual disability. Recognized syndromes associated with ASD often presenting in infancy. Elimination diets. Facilitating collaboration between healthcare providers and carers. Treatment. Issues. Chapter 13. Presentation of Asperger syndrome in middle childhood. Relevant developmental challenges. Play and socializing with peers. Learning challenges. Social demand. First suspicions of ASDs presenting in middle childhood. Asperger syndrome presenting in middle childhood. Red flags of Asperger syndrome presenting in middle childhood. Red flags for ASD. Screening. Illustrative case history Asperger syndrome presenting in middle childhood. Presenting symptoms Asperger syndrome presenting in middle childhood. Primary handicap. Secondary impairments in AS presenting in middle childhood. Tertiary disability Asperger syndrome presenting in middle childhood. Differential diagnosis Asperger syndrome presenting in middle childhood. Obsessive compulsive disorder. Sensitivity. Schizophrenia. Other associated conditions. Causes of ASD. Multidisciplinary involvement. Teacher. Speech and language therapist. Educational psychologist. Paediatrician. Child and adolescent psychiatry team member. Child psychotherapist. Investigations. Intervention. Home-based. Health services. School based. Child-based. Chapter 14. Presentation of Kanner syndrome in middle childhood. Kanner's syndrome in the context of learning disability. Red flags of Kanner syndrome in the context of learning disability. Diagnostic criteria of Kanner syndrome in the context of learning disability. Illustrative case history of Kanner syndrome in the context of learning disability. Presenting symptoms of Kanner syndrome. Tertiary disability. Investigations. Intervention. Issues. Chapter 15. Presentation of Asperger syndrome in later childhood and adolescence. Relevant developmental challenges. Agency. Identity. Presenting symptoms. Primary handicap. Secondary impairments. Tertiary disability. Diagnosis. Differential diagnosis. Differential diagnosis of communicative disorder. Differential diagnosis of repetitive behaviour. Differential diagnosis of social impairment. Associated problems. Investigations. Management. The primary handicap. Secondary handicap. Tertiary handicap. Issues. Normalization and mainstream education. Chapter 16. Presentation of atypical Asperger syndrome, often with ADHD, in late childhood and adolescence (secondary school and college). Relevant developmental challenges. Belonging, giving, and taking. Self-control. Who are the atypical group? Red flags. Screening. Illustrative case history. Diagnosis. Presenting symptoms. Primary handicap. Differential diagnosis. Associated problems. Aetiology. Investigations. Treatment. Issues. Victimization. Chapter 17. The presentation and consequences of Asperger syndrome in adulthood. Challenges in assessing adults. Relevant developmental challenges. Asperger syndrome in adulthood. Illustrative case history. Illustrative case history of a woman. Gender differences. Presenting symptoms. Differential diagnosis. Associated problems. Aetiology. Investigations. Intervention. Issues. Appendix 1. Ethics and ASD. Appendix 2. An example of a pre-interview questionnaire. Subject Index. Author Index.

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Professional text covering research, treatment, diagnosis, intervention and support for people with ASD from birth to old age

About the Author

Digby Tantam is Honorary Consultant Psychiatrist and Psychotherapist for Sheffield Health Care NHS Foundation Trust and an Emeritus Professor at the University of Sheffield. He is a chartered psychologist, and a fellow of the British Association of Counselling and Psychotherapy and the United Kingdom Council for Psychotherapy. Educated at Oxford, Harvard, Stanford, London and the Open Universities, and with a doctorate from the Institute of Psychiatry in London, he started a clinic for adolescents and adults with autism spectrum disorders in 1980 that has continued ever since. He has written numerous articles and books on ASD and other topics, including Can the World Afford Autistic Spectrum Disorder?, also published by Jessica Kingsley Publishers.

Reviews

Digby Tantam provides the reader with a well-researched, objective summary of the neurophysiological, genetic and psychosocial theoretical aspects of autism spectrum disorder... A detailed picture of the complexities and difficulties associated with partialling out diorders is outlined, facilitating clinical practice and appropriate treatment plans..well-written book... I would highly recommend this book for anyone who wishes to have a comprehensive overview of autism spectrum disorders.
*Irish Journal of Medical Science*

These consideration by Tantam are just a taste of the overall mood that flows through the entire book, his insight and compassion towards people with ASD who struggle every day, recognising that this may be considered an asset... unquestionably an essential resource for all professionals who work with people with an ASD... indispensable reference for students and professionals such as paediatricians, psychiatrists, clinical and educational psychologists, as well as many other professionals working with individuals of all ages with autism... I would recommend this book to anyone, including carers or people with ASD who want to know about the most recent research into the etilogy, treatment and presentation of these disorder.
*Annali, Dell'Istituto Supreiore di Sanita*

If you only acquire one book on autism, then this should be the one. Digby Tantam is an international expert in the field of autism spectrum disorders and what he does not know about the subject is not worth knowing... Covering all the latest thinking and knowledge with regards to autism, this is a formidable and satisfying read.
*Nursing Standard*

This substantial textbook brings together all the latest research and clinical practice in the assessment, diagnosis and treatment of individuals with autistic spectrum disorders...

This book is impressive in its scope.
*SEN Magazine*

Any reasonably educated and determined parent who wishes to gain a better understanding of their child or themselves, a more holistic view of past and present theories would gain from reading this book. .. I probably enjoyed this book more than any other I have read specifically on autism due to the brain research. It is the Ramachandran, the Oliver Sachs of the autism world - a book for academics but also accessible to the educated and determined parent.
*asteens*

Digby Tantam has worked with people with autism spectrum conditions for over 30 years. This experience has made him aware of the remarkable variations in the clinical pictures to be found in people on the spectrum. To take just one aspect, they can vary from those with severe or profound learning disability right up to those of remarkably high ability, even genius level, in specific areas. However, the author emphasises that they all share a major problem affecting non-verbal communication. This type of communication he considers essential for the "unconscious link between people". Is this the basis of the social instinct?

The author discusses in detail, but with great clarity, what is known of the physical, neurological and genetic findings in people with autism spectrum conditions, and the developmental, social and emotional factors, including changes with age, that have an equally important effect upon the clinical picture. He also discusses the prevalence and methods of treatment.

This fascinating, and intriguing analysis of the remarkably diverse picture to be found in autism spectrum conditions makes this book especially unusual in the published literature of the field, and essential reading for both professionals and parents.
*Dr Lorna Wing, Consultant to the NAS Lorna Wing Centre for Autism*

This is a unique and timely contribution to the literature on autism. The National Autistic Society of the UK will be 50 years old in 2012. Many of the children who attended its first school are now approaching old age.

In this astonishingly comprehensive and well researched book on autism through the lifespan, Digby Tantam's long and eminent career as a leading academic, researcher and clinician is evident throughout. His thorough examination of the science and the various theories of autism is matched by an engaging and straightforward style that makes even the most complex aspects accessible. His use of case examples also reveals a deep understanding of the true nature of autism - empathy for 'autistic thinking' and recognition of the 'strengths' of autism juxtaposed with recognition of the very real difficulties that may be present. Respect for difference and diversity is noticeably informed by research and a solid first hand clinical background and experience. It is consequently unsentimental, wise and practical.

Due to the breadth and depth of this book I would recommend it as an investment that will be invaluable not just for academics, clinicians and researchers but a much wider readership that will include the autistic community and those who support them.
*Richard Mills, Director of Research, The National Autistic Society UK and Research Director, Research Autism, London*

This authoritative, comprehensive textbook by Professor Tantam, an internationally recognized expert, provides an overview of Autistic Disorder ranging from an historical perspective to our current knowledge of its clinical presentation, life course, underlying pathology, etiology, and treatment. It fills a void in the literature, and I predict it will become "the standard reference" for students, clinicians, and researchers working with Autistic Disorder.
*Edward R. Ritvo, MD, Professor Emeritus, UCLA School of Medicine*

This is probably the most comprehensive and wide ranging book on ASD I have ever read. It is an extraordinarily rich mine of information from neurobiology to treatment, and from infancy to adulthood. 'No stone is left unturned'. An original and perhaps controversial feature is the highlighting of links between ASD and ADHD.
*Professor Margot Prior AO, FASSA, FAPS, Department of Psychology, University of Melbourne, Australia*