by Manuel Casanova

I presently live in New Orleans where paranormal phenomena, ghost tours, voodoo and vampire practices are deeply imbedded in our folklore.  Over the last hundred years people trying to ascertain the validity of these phenomena have recorded data stemming from temperature drops, visual sightings and unusual electrical fluctuations. They call this the “scientific method”. At most, the validity of paranormal phenomena are based on observations stemming from arguable methodology. In a certain way, this all reminds me about diagnosing autism. 

I remember sitting down with my dear friend the late Isabelle Rapin. She was in the midst of editing a book on autism and was giving her guidelines to prospective participants. “First of all, I do not want every chapter to start by telling me what autism is”, she said. “Second, I want everybody to understand that the diagnosis of autism is based on observing behaviors”, she added. Indeed, there is no laboratory test indicative of autism. It is all about the subjective appraisal of behaviors.

The problem with subjective appraisals of behaviors is the fact that they rely on the whim and baggage of the observer. Although behaviors may remain the same, their interpretation by clinicians may deeply vary one from another: what is fidgetiness for one person may be anxiety to another. Such judgements are biased by how a clinician perceives them. It is a digital assertion that offers no leeway to falsify the same.  In this regard, diagnostic classifications are dogmatic in character and based on the credence of those selected few participating in definition committees.

I have found it uncomforting that the classification of autism offers little play for the rich variety of symptoms expressed in autism.  In a clinical session, a nonverbal autistic child may be observed using his mother as a stepladder in order to reach an object on top of a table. Another child may reject close touch while being carried in arms by his mother. In the end, he flops backwards and remains hanging, like a bat, upside down by his legs. How do you accommodate for those behaviors in the present clinical classification and how much weight do they provide for a diagnosis?

In this book I have tried to cover the rich variety of symptoms expressed by autistic individuals.  The aim is not to use symptoms for diagnostic purposes but, rather, identify and target them for therapeutic efforts. Clinicians lament that there are no curative interventions in autism. Still, symptomatic treatment may focus on distressing ailments that affect the quality of life of the affected individual and that of his family. 

I would like to impart upon the reader a couple of pearls of wisdom that I have picked along the way of my medical carrier.  First of all, if you notice one accessory symptom, look for others. These symptoms never seem to occur in isolation. If a patient has unexpected emotional reactions, he/she may also have unusual eating habits, sleep disturbances, abdominal discomfort or impulsive behaviors. In autism, accessory symptoms seem to cascade together with each symptom triggering or worsening another. Second, treating one accessory symptom may lead to unexpected benefits in alleviating other manifestations.  Recognizing and treating the source of abdominal discomfort in a patient may lead to better sleep habits, better attention paid in the classroom, and even to increased socialization.

This book is based on many of the chief complaints brought to me by my own patients.  Over the years I have had the opportunity to reflect upon these symptoms and perform some research.  I have found that offering patients the results of our research help reduce uncertainty, fear and concern. Similarly, I hope that armed with the knowledge gained in reading this book will allow you to reassure your loved one that you care and stand ready to help them.

This book is available now on Amazon!