Knitting Perspectives. Review: The Autistic Brain: Thinking Across the Spectrum. Review by Robert L. Findling, M.D., M.B.A.

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1 Knitting Perspectives Review: The Autistic Brain: Thinking Across the Spectrum Review by Robert L. Findling, M.D., M.B.A. 1

2 We do not fully understand the neurobiology or the precise causes of autism. While this assertion may be valid, the pace at which researchers are generating scientifically sound information about this syndrome has increased substantively in recent years. The Autistic Brain, co-authored by Temple Grandin and science author Richard Panek, is a compelling work that effectively communicates and interweaves several perspectives on autistic disorder that might otherwise seem divergent. As many readers familiar with autism are aware, Grandin received a doctor of philosophy degree in animal sciences, is a professor of animal science at Colorado State University, and has written and spoken extensively about her own experiences as a person with autistic disorder. Perhaps the world s most famous autistic person, the 62- year-old, cowboy-shirt-wearing Grandin is an animal scientist and slaughterhouse designer who has helped people break through the barriers separating autistic from nonautistic experience. Grandin s fourth book is both a cogent summary of scientific advances in the field and a personal, firsthand account of the clinical relevance of such research. This makes the book truly translational at its core. In the first chapter, the authors use Grandin s own clinical care as a child as a heuristic reference to how autism has been conceptualized over the years. The authors then engage in a cogent discussion of whether autism could be considered a form of brain damage or a psychological outcome of poor parenting, from both a historical standpoint and a personal perspective. The chapter also contains 2

3 thoughtful analysis about the impact that nosology has had on people with certain features, such as extreme social anxiety or an autism-spectrum diagnosis. Although the authors are not timid about rendering their own opinions, they effectively communicate their rationales by extrapolating scientific evidence. Other chapters focus on recent advances in neuroimaging and genetics. The chapter on neuroimaging provides a thoughtful and succinct overview of both the promise and the limitations of this research tool in a way that readers without a neuroscience background can understand. Using, in part, Grandin s techniques from her teaching as a university faculty member, the authors provide a brief primer of the anatomy of the brain, followed by a discussion about the relationship between the clinical correlates of structural brain imaging and behavior. The authors also consider the relevance of functional imaging and studies of brain connectivity to the study of autism, as well as genetics research and its relevance to people with autism. One particularly interesting chapter focuses on sensory problems in people with autism. According to the authors, sensory disorders appear to be quite common in people with autistic disorder. Grandin notes that some people are oversensitive to stimuli, not responsive enough, or likely to seek out certain types of sensory experiences. Despite the fact that these phenomena are both prevalent and highly distressing to people who experience them, the scientific literature on the topic is surprisingly scant. The same chapter also addresses processing problems associated with the five senses. One of the 3

4 unique aspects of the book is that its authors suggest means by which to identify people with specific sensory-processing difficulties. In addition, it includes helpful suggestions about how to lessen the burden of people who have these problems. The authors then grapple with the shortcomings of our descriptive nosology, as well as the putative impact of changes associated with going from DSM-IV to DSM-V (codes that mental-health professionals use to describe the features of mental disorders). Grandin and Panek note that autism is associated with behavioral features in addition to interpersonal ones, albeit oftentimes to a greater degree than in people without autism. Referring to focusing on a single descriptor outside of the context of an individual s unique circumstances as label locked thinking, the authors make a compelling argument about how the scientific study of single symptoms, rather than on broader and less precise diagnostic entities, could inspire others to view people with autism as individuals. The next chapter considers putative strengths of some people with autism. Perhaps more important, the authors discuss how these strengths might manifest themselves in real-world settings. One such strength is attention to detail; another asset is the ability to identify patterns that others do not readily discern. What follows is a chapter that considers putative means by which people with autism might be more successful in mainstream society. The authors do not minimize the vicissitudes of people with autism. Rather, they focus on assets upon which successes can be built. 4

5 Due to Grandin s personal accounts of her experience with autism, The Autistic Brain is very thoughtfully written. It discusses recent scientific advances about autism in an easily understandable format. At the same time, the authors do a good job of not oversimplifying the material. They pose thoughtful questions about why key clinical features of autistic disorder have not received the amount of scientific research they deserve. Readers will come away from this book appreciating the challenges associated with scientific pursuits while realizing where gaps in research exist. But what makes this book unique and compelling are its firsthand accounts of how autism impacts a person s life, its explanations of why scientific advances matter, and its consideration of the potential strengths of people with autism despite their difficulties. 5

6 Robert Findling After serving as the Rocco L. Motto, M.D. Chair of Child and Adolescent Psychiatry at Case Western Reserve University School of Medicine and director of the Division of Child and Adolescent Psychiatry at University Hospitals at Case Medical Center, Robert Findling, M.D., M.B.A. joined Johns Hopkins in 2012 as director of Child and Adolescent Psychiatry and vice chair in the Department of Psychiatry and Behavioral Sciences. He is also the vice president for Psychiatry Services and Research at the Kennedy Krieger Institute in Baltimore. Dr. Findling earned his undergraduate degree at Johns Hopkins University and received his medical degree at the Medical College of Virginia. He completed training in Pediatrics, Psychiatry, and Child & Adolescent Psychiatry as part of the Triple Board joint training program at Mt. Sinai in New York. He subsequently earned his Masters of Business Administration degree at a joint program run by the London School of Economics and Political Science, the New York University Stern School of Business, and the HEC School of Management in Paris. 6

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