Reweaving the Autistic Tapestry

by Lisa Blakemore-Brown
Jessica Kingsley, 2001
Review by Marilyn Graves, Ph.D. on Sep 11th 2002

Lisa Blakemore-Brown has written a helpful and detailed book about children in the autism, aspergers, and attention deficit hyperactivity spectrum of developmental disorders. These children may be very different from one another, very much themselves, but share common impairments. They are unable to learn in the same way most children learn and they are unable to take advantage of the richness of their social and academic worlds. A worthy idea, Blakemore-Brown proposes using the metaphor of weaving to describe and promote thinking about the spectrum of disorders including autism, aspergers, and ADHD. Perhaps what the weaving metaphor speaks to is the need to individually tailor a comprehensive intervention program for each child making an individual tapestry for that child in the form of a treatment plan which details his or her particular strengths and weaknesses. Other well-known professionals in this area including Russell Barkley have endorsed the idea that the three disorders may be better thought of as part of a broader spectrum. Although not covering quite the same territory in terms of theory or diagnostic spectrum, Rudolf Ekstein’s 1966 magnificently well-written Children of Time and Space of Action and Impulse is a good read for those interested in this general subject.

Blakemore-Brown has a private practice conducting psychological assessments of children to diagnose autistic spectrum disorders. Her examples of actual test reports are extremely helpful. Her comprehensive evaluations contain developmental and social history for the child being tested. Test results include measures of academic achievement, IQ testing scales such as the Wechsler Intelligence Scales for Children, and behavioral rating scales like the Conners Scales. She then provides a detailed conclusions section and a comprehensive outline of the needed treatments for the child. Often these interventions involve parents, schools and a variety of treating professionals like speech therapists, occupational therapists, physical therapists, music or dance therapists, counselors, doctors and life coaches.

Her book has detailed chapter summaries in the introduction section so that readers can more easily find specific information. Blakemore-Brown’s writing style is a bit stiff and overly formal. She says her intent is “to provide a springboard from which families, professionals and other interested individuals can examine some of these issues and creatively explore how human development, and in particular the development of positive social engagement with others and successfully planning and action through life, in an interweaving dynamic process” (p. 15).

Her overarching metaphor of the tapestry warp and weft, interbalancing and patterning speaks to the complexity of the child within the autistic spectrum of disorders. Helping to make sense of such a complex pattern may enable parents and treating professionals to emerge from what seems like a tangled spider’s web of contradictions. She shows how the three disorders compare in terms of levels of severity and symptom patterns, examining attributes like social language skills, nonverbal cuing, motor skills and attention skills. She compares the spectrum of disorders with other difficulties like dyspraxia, Tourette’s, hydrocephalus, and non-verbal disorders.

The first half of her book examines antecedents to the disorders which can cause disturbances in normal development. Some of these include metabolic problems, viral infection, allergic reactions, and brain injury. She examines difficulties in several basic areas in a comprehensive way emphasizing the need for consistent interventions. She says, “Weaving normal developmental tapestries requires the careful execution of a plan and the weaving process involves repetitive, rhythmic, and balanced actions as the story is developed” (p.34). She then examines difficulties with reciprocity which in a severe exacerbation lead to children being unable to understand or sympathize with the perspectives of others. She explains puzzling compensation mechanism like obsessive thinking and compulsive repetitions.

Blakemore-Brown provides an overview of diagnostic information and examines co-morbidity factors. She says that one must understand diagnosis in this area as referring to a cluster of observed behavioral features often associated with biological causes but this is a grey area and there are “interweaving features” (p. 104). Diagnostic categories of the DSM IV are, she thinks, too rigid. She argues for a “dimensional rather than a categorical approach” (p.122).

The last half of the book outlines issues related to treatment interventions. She points out some of the failings of our current system, rather passionately at times. Faults include leaving diagnosis and treatment till the child is older out of a reluctance to label the child, long waiting lists to get treatment, unwillingness of some schools/institutions to work with outside specialists, cynicism, reluctance to believe in the process, blaming the parents and being overly brief and informal in assessments. She sees the need to untangle the system.

Some of the interventions she suggests are identifying triggers, reducing stress, managing behavior, and doing careful monitoring. She discusses the use of modeling, imitation and transfer of learning. She lists the components of a successful intervention: high family involvement, intervention teaching, comprehensive language services, pragmatic behavioral intervention, predictability of environment, and imitation training. She points out that not all things work or every child. For example, some children may need diet changes or home-based interventions while others may not. She also advocates the use of support groups for parents like CHADD or NAS. She explains some of the promising and effective treatments like the PECS or Picture Exchange Communication System. The PECS uses a series if cards which visually depict aspects of the child’s world. It is helpful with children who are primarily visual learners. There is also Gray’s Comic Strips for teaching social skills available from the Gray Center in Jenison, MI.

Appendix 1 lists the criteria for diagnosis of autism, aspergers and attention deficit hyperactivity disorder for both the DSM-IV and the ICD 10 methods of classification. This may be especially helpful to parents who may not have access to this information elsewhere. They can see exactly what caused a school or treating professional to give their child a particular diagnosis.

Appendix 2 is a list of resources for the UK, USA, and other world sites with helpline numbers or web page addresses. Included are resources for finding an ADHD coach, a growing new area of intervention. There is a listing of residential placement centers for children who have problems so severe they cannot be treated on an outpatient basis. There are listings for the TEACH method developed by the University of North Carolina at Chapel Hill, the Tomatis Method (a listening therapy), variations of the Lovaas Method of behavioral intervention, The London Autism Project, the Son-Rise project for home-based interventions, Auditory Integration Training (Ilford, Essex) and others.

Marilyn Graves, Ph.D. is a clinical psychologist in private practice working with children, adolescents and adults.

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