book review

This was an unusual read.  The idea, I think, is to appeal to and teach more visual autistic people.  While this category does not include me, the idea itself is sound.  Teaching in pictures rather than textwalls is a very reasonable way to try to make this knowledge accessible. I didn\’t love the picture quality, or perhaps the printing quality, of the book itself.  Sometimes the pictures were hard for me to parse, though that could also be my poor visual processing capabilities shooting me in the metaphorical foot.

The implementation was, um… well, probably as good as could be expected, really.  The problem with trying to teach real life social skills is that the types of reactions, facial expressions, postures, etc, vary on the person and situation.  The pictures in this book were taken of people posing for these situations, not of actual live situations.  So as good as the intentions were, as an autistic person who has learned to interact relatively successfully, I didn\’t personally think the pictures really conveyed the kind of visual information needed to truly generalize from.  The pictured people tended to over-act their body language and use stiltedly formal verbal language (like saying \”do not\” fairly often instead of \”don\’t\”). 

Obviously, doing this can help get the point across more clearly to new students of body language, but I\’m not sure the method is good for anything other than the most basic introduction to the subject.  Which I guess could be the point?  But if so, where\’s the advanced version?  Where does someone who\’s mastered these basics go?  There\’s a great deal more to social skills than these very few situations listed in the book.

Also, despite the title, I really feel like most of the situations listed in the book are more for late elementary school to middle school, not high school and beyond.  By the time you\’re in high school, you should probably be familiar with these skills and trying to learn more advanced ones.  Which makes me wonder if the book is actually meant for middle schoolers and they\’re just being clever with psychology.  Y\’know, the \”well this is only supposed to be for the older kids, but you\’re pretty cool so we\’ll make an exception this time\” trick that younger kids and people with low self-esteem (see: most middle schoolers) eat right up because they want to feel like they\’re mature and worthy.  

About the only section I read and said \”yeah, sure, this is for high school and beyond\” is the very last one, the one that deals with interviews.  And even then, while the advice is good, it\’s very very basic.  

So, the very first thing to note here is that the author repeats quite often that he has no theory of mind.  Theory of mind is the skill of putting yourself in another person\’s shoes and trying to imagine how they might be thinking or feeling.  It\’s what you use to predict whether a joke will be funny to your audience.  It gives you the information you need to know whether someone is being sarcastic. 

If you\’re familiar with the concept of theory of mind, you\’ll recognize how fundamental this is to communication.  When you make jokes, or decide what subject to talk about, or even decide whether to start a conversation, you use theory of mind to decide what kind of joke is appropriate, what subject that other person would be interested in, and whether the person is going to be receptive to a conversation at all. 

For example, when I go to start a conversation with my spouse, I can make the assumption, based on what I know of him, that he will be interested conversations about the trading card game Magic: The Gathering.  I, personally, am not interested in this subject much, so without theory of mind I might assume no one was interested in Magic: The Gathering and never talk about it.  People without theory of mind don\’t see beyond their own point of view. 

Maybe a more important example is in how my spouse and I handle reconnecting post-argument.  With theory of mind, I know that my spouse appreciates hugs after we\’ve been at odds with each other.  Without it, I would assume that my spouse, like myself, would prefer some space to calm down and mentally distance from the argument.  If you suddenly hug me after an argument I am likely to react very poorly, which is why it\’s good that my spouse tends to ask for hugs after arguments rather than demanding them or just starting them without warning.  But if I always walked away to get my space and distance after an argument, my spouse would feel hurt and alienated.  So theory of mind helps both of us communicate and reconnect. 

Lacking theory of mind, therefore, is a significant disability, which I hope I\’ve made clear here.  Notably, lacking theory of mind is not a specifically autistic trait.  It\’s a trait that can go along with autism, but it is not specifically autistic.  I can say that because I\’m autistic, and several people I know are autistic, but we all have theory of mind. 

There\’s a catch to that ownership of theory of mind, though.  That is: the more different the mind is from your own, the harder it is to have a theory of it.  Autistic people are simply different. Not less, but definitely different.  So like my example above, my spouse (and many neurotypical humans) prefer to re-establish physical closeness after an argument.  This is affirming and positive for most people.  It says, on an emotional level, \”I am still close to you and care about you.\”  That kind of affirmation is a very good thing after an argument and hurt feelings. 

For me, though?  If I\’m upset (and I usually am after an argument), my skin is going to be extra sensitive.  Touch, especially hugs or other kinds of closeness, will actually hurt or at least be unpleasant.  So my preference is to go off by myself and cool down so I can refocus and move past the argument.  I already know my spouse loves me, and giving or receiving a hug will not change that to me.  So in this way, my spouse and I differ fundamentally. 

(If anyone is curious, the compromise is that we usually hug or have some kind of touch, and then my spouse leaves me alone so I can cool down.)

I have theory of mind, but what\’s normal for me isn\’t what\’s normal for most people.  I have, therefore, had to learn to figure out specifically what\’s normal for neurotypical people, bit by bit.  I have a talent for recognizing patterns, which is also somewhat an autistic thing, so that helped me learn. 

However, it\’s something like trying to learn what\’s normal for another culture, or even what\’s normal for aliens.  Y\’all simply don\’t work, act, or think like me.  So I, and other autistic people with theory of mind, have a much harder time using theory of mind.  Even though we often have it. 

Theory of mind explanation aside… reading this book made me kind of sad.  Like many autistic adults, there\’s a lot of frustration in the author\’s memoirs.  A lot of alienation, a lot of miscommunication, and a lot of forcing himself to do things he didn\’t want to and knew ahead of time was going to make him miserable. 

The book is all of 55 pages, so it\’s not a long read and it does, as advertised, give you a sense of what it\’s like to be the author.  This was made more interesting to me by the fact that he\’s Irish, so there\’s bits and pieces of that culture in the stories. 

Read This Book If

That subtype is basically: visual thinker, no learning disabilities, average to high IQ, mainstream education, fully verbal, no physical disabilities or conditions like epilepsy or cerebral palsy, and fixated on special interests with no general curiosity.

You can essentially look up information on subjects like anxiety, conversation, teasing, sarcasm, and courtesy.  Each has a short section (less than 5 pages) and comes with a \”See also:\” for related subjects.  There\’s a significant amount of repetition of concepts, since some subjects overlap in places.  The overall message is what\’s in the title: autistic people are different, but you shouldn\’t give up on us.  The book is meant to help you understand and give you immediate ideas of what to try.  Sound great, right?

Honestly?  I didn\’t really like this book.  It got a lot of things right, but in some cases it did so in the worst way possible.

For example, one of the early sections talks about meltdowns, and how they\’re different than tantrums.  The issue?  The book doesn\’t use the word meltdown.  It insists on giving you two different definitions of \”tantrum,\” and explaining the autistic meltdown in great depth but not using the obvious word for it.  The content is more or less accurate, in that meltdowns are not about control or getting what you want, but about being overwhelmed or overstimulated and not being able to handle it.  If there\’s a perfectly good word to distinguish a not-tantrum from a tantrum, I can\’t understand why you wouldn\’t use it.

I also didn\’t like the \”one size fits all\” stereotypes the book liked to trumpet.  The thing about autism is that it\’s a spectrum.  The well-worn saying is, \”If you\’ve met one person with autism, you\’ve met one person with autism.\” That includes the subset like myself who were given the label \”Asperger\’s Syndrome\” instead of \”autism\” or \”high functioning autism.\”  There are going to be differences, so saying \”all Aspies do this\” or \”all Aspies have this problem,\” or \”Aspies think like this\” is a massive red flag, and wrong to boot.

This book has tons of those massive red flags.  A personally irritating example is in the section about taking an interest in other people.  The book opines that autistic people are not interested in others, which is a problem because that behavior is expected.  It then says, \”Can we rewire the brain to insert an interest in people?  No, unfortunately, there is no way to hardwire in social thinking.\”  And then talks about how you can train autistic people to fake interest in others so the social expectation is fulfilled.

So, excuse me?  I\’m an autistic person with a general interest in everyone and everything, including other people.  I have had that interest since I was young, and have only gotten better at expressing it as I aged.  I wasn\’t aware that I apparently don\’t exist, thanks for that heads up (sarcasm).

Speaking of ways I don\’t exist, there were a couple mentions of gender talks and dating.  While I absolutely agree it\’s important to discuss these things, the assumption the book makes, that autistic children will be cisgender (either male OR female, both, transgender, or none of the above) and only care about straight dating (never mind all the gay and bi folks), is woefully shortsighted.  Autistic people often find ourselves in gender minorities.  I myself am agender, which puts me in the transgender category…  and apparently again, I don\’t exist.  Talk about LGBTQIA issues, for Pete\’s sake.  It is 2020 and sex and gender are way more complicated than, \”did you check what\’s in their pants?\”

And speaking of things that are outdated…  This whole book, while published in 2009, seems to be stuck in the 90s.  Paper and pencil solutions are stressed.  Phone skills and analog clock-reading skills are pointed out as important.  Look, I get that not every person has a smartphone, but these days, even under the poverty line, it\’s the vast majority.  Children these days are more likely to use a smartphone for organizational solutions, text far more than call, and use their cell phones for clocks rather than squint at a clock with hands.

There\’s a time and place for paper-and-pencil solutions, or whiteboards, or what have you.  But the issue of smartphones was basically entirely ignored throughout the book, and that strikes me as a staggering oversight.  Particularly when talking about bullying.  The book focuses only on in-person bullying, but cyberbullying is now quite common and badly needs addressing in great detail.

My last criticism is that the book seems steeped heavily in the ableist \”autism separate from child\” mentality.  The fallacy in Autism $peaks\’ publicity stuff is that the autism can somehow be peeled away from a person, \”freeing\” the normal human underneath, or some such nonsense.  This shows up in various points in the book, but the one that irked me enough to note it down was on page 163: \”Unlike more severe autism, Asperger\’s syndrome is surmountable to a degree.\”

Hi, it\’s me again, the twice-nonexistent autistic human!  My autism is not a chronic disease.  I have learned to function in your bullshit neurotypical society, but that does not mean I have somehow \”overcome\” my neurology.  I am still autistic, and I will still be autistic even if I solve all my health problems and function at my very best.  Please don\’t imply my existence is something to be \”surmounted,\” and if I just try hard enough I\’ll be \”normal.\”  Yikes.

This is probably the most blistering review I\’ve written and opted to publish, and I think the book bothered me because it got many things right but missed the mark in so many important ways.  The authors spent hundreds of hours around autistic kids, but it\’s like they never spoke to autistic adults or even heard of neurodiversity at all.  I hate to belabor the obvious, but like… maybe do that before you publish your book next time?

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Jennifer O\’Toole is a lot of things, as a person, and this book is a look into many of them.  It was also painfully familiar to me in a lot of ways.  The difference is that her story is moreso than mine; she reached more tremendous highs and plummeted to significantly more painful depths.

A major difference here is that while the author embraced her femininity, using it as a pattern and a framework with which to understand her life and self, I ignored mine until I found a word that actually does describe my gender: agender.  Effectively, I would most prefer you leave your gender expectations at the door when meeting and interacting with me.  I am not masculine, or feminine, or both.  I am \”no thank you.\”

I was fortunate enough to be born to parents who allowed me to be myself, even if \”myself\” was painfully unfashionable and insisted on wearing sweatpants into high school.  Because my parents didn\’t actively enforce gender roles, I was able to grow without pretzeling myself into stereotypes I hated, or dealing too much with dresses, skirts, high-heeled shoes, and a million fiddly accessories which only lend themselves to accentuating the fact that that women are reduced to the attractiveness of their bodies.

A lot of autistic people find themselves in the gender minority camp, apparently.  But we live in a world where gender roles and stereotypes are still very much in effect.  And of course, as the book points out, many autistic people are born genetically female and not recognized as autistic.  So a book like this is exceedingly valuable, because in Jennifer\’s experience being autistic and female, we can find echoes of our own lived experience.  And not only that, but she also points out her pitfalls and failings honestly, which allows us a better chance to avoid those pitfalls.

I found this a difficult book to read.  Not because of the writing style, which was quite easy to read.  Not because of the length, which was less than 300 pages.  It was the subject material, which often struck very painfully close to home.  The question of, \”how can I be so smart and still feel so stupid?\” is all too real to me.

\”Spiky skills\” is sometimes how this phenomenon is phrased, where the person has great strengths in some developmental areas and skills, but in others, barely scrapes by.  In autistic people, the obvious example is being a trivia god/goddess (whether that trivia is trains, edible plants, or classical literature), but never knowing what to say when someone is upset, or even what upset them in the first place.

The author focused less on the social difficulties, and more on Executive Functioning difficulties.  Charmingly, she does so by starting with Santa.  I especially recommend reading this section.  It\’s shockingly easy to read for a lesson on brain science, first and foremost, but also because Executive Function isn\’t well understood despite being incredibly important to understanding autism.  There\’s a lot to unpack and understand about it, and doing so can help you understand your autistic loved ones better.

I honestly don\’t believe I\’ve read a clearer, more approachable description of Executive Function anywhere, ever.  So while I strongly recommend the entire book, I wish that particular section was required reading for every autism-related professional, and given to every parent and newly-diagnosed autistic person.

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This is a book that covers more than autism, but as most parents with autistic loved ones know, you don\’t usually just get \”autism and no other problems.\”  There\’s usually gasto-intestinal issues, food allergies, intolerance of food dyes, and sleep difficulties.  This book covers all of those things.  The title is a bit deceptive, in that the author doesn\’t necessarily think it\’s reasonable for every child to cut pharmaceuticals out of their lives. 

However, what she does say is that many conditions which are typically treated with pharmaceuticals, like depression, inability to focus, hyperactivity, and digestive issues… can be treated more effectively with better nutrition and possibly dietary changes.  Instead of treating the symptoms, you can eliminate the cause of the problem itself, which might be something like a zinc deficiency or magnesium deficiency.  The end result, naturally, is a happier, healthier child.

I personally suffered from both of those deficiencies, and it seems I also have some form of allergy to dairy.  And possibly gluten, but I\’m studiously ignoring that right now because the idea of trying to go gluten-free is painful to contemplate.  As I understand it, this is a common dread for parents of autistic people.  Good news!  This book has resources to help. 

Actually, on the subject of nutrition and food allergies, this book has something I\’ve never seen anywhere else: DIY infant formula.  Babies can be allergic to foods, and if the mother eats those foods or the infant formula contains them, the baby can suffer those allergies.  But because they\’re babies, they can\’t really communicate the specifics of their distress.  My spouse\’s mother eventually had to cut cow milk and dairy out of her diet when breast-feeding him, because he was apparently lactose intolerant from birth.

While removing cow dairy from a diet might be complicated, at least it was just one factor.  For some people on the autism spectrum, it\’s more than one thing.  The author talks about her struggles with feeding her son, who had a lot of food allergies and eventually, despite all her efforts, could not be breast-fed.  The authors talks about how to test for these sorts of things in children of all ages, as well as reasonable coping strategies for managing meals.

I say \”reasonable\” because high-needs people can test positive for allergies to dozens of foods, and trying to cut all of those foods out of a diet is exhausting at best.  The author quite rightly points out that it can also lead to malnutrition.  So she suggests (repeated throughout the book, so as to really get the point across) that you should get the tests done, and then choose the 2-4 strongest reactions to eliminate from the person\’s diet.  The rest should be cycled, or eaten sparingly once or twice a week.  This method limits the amount of exhaustion a parent faces when trying to provide meals and appropriate nutrition for their loved one.

The book also discusses specific supplements, from fish oil to amino acids to brain chemicals like GABA.  There were things I\’d heard of, like magnesium and zinc, and things I hadn\’t, like tyrosine and glutathione.  Each comes with the sort of educated advice and symptoms list you would expect when visiting a specialist doctor… which is the author\’s credentials, of course.  It\’s just usual to have put into a book, when this advice will typically run you hundreds to thousands of dollars. 

Naturally, you shouldn\’t simply pick up this book and try the things in it without any form of professional guidance.  While I found this book astonishingly accessible and thorough about its information, there\’s always interactions between pharmaceuticals and supplements.  Some of those are covered in this book, but for your loved one\’s safety, consult a trained professional before adding things. 

Overall, this was an excellent read.  High quality information, significant but not overwhelming resources, written in an accessible-to-all style.  While I don\’t agree with absolutely every recommendation in the book, the author seems quite knowledgeable and in-tune with this subject.  I might consider buying a copy of this book and having it on hand to give to parents who come to the parent support group.  The kinds of symptoms they complain about, including unusual things like the \”white diet\” where the child will only eat milk, cheese, pasta, etc, are addressed in these pages.

Read This Book If

I\’m typically cautious to the point of pessimistic skepticism when reading about specific therapies and how they\’re supposed to \”improve\” autistic people.  This is possibly because Applied Behavioral Analysis (ABA) is the biggest of these therapies, and it is all-too-often abusive.  But I\’d heard good things about the Floortime method, so despite this book being 400+ pages, I gave it a read.

I was not disappointed.  While the book is dense and not written in a way that\’s easily accessible to a frazzled parent, the approach it\’s trying to communicate is excellent.

Unlike ABA, which typically just tries to elbow autistic people into \”normal behavior\” via bribery, Floortime instructs parents and caregivers to enter the autistic person\’s world.  Instead of invalidating our experiences and existences in pursuit of some imagined norm, the aim is to develop connection, warmth, stability, and then, communication and reasoning skills.

Floortime recognizes the autistic person as a person.  Perhaps a person with difficulties, sensory or biological or emotional, but a person deserving of kindness, care, and attention.  A person with autonomy and feelings, regardless of what level of apparent functioning they\’ve reached.

Floortime also refuses to assume a limit on how far an autistic person can develop.  It lays out the developmental steps for communication and reasoning, but then says on page 125: \”Never assume a ceiling on a child\’s abilities.  Always assume you can get to one more level, and after that, one more level.\”

The writers are aware that people may have limits, and may only be able to develop to a certain point, but they prefer to err on the side of assuming competence and assuming potential rather than possibly limit a person\’s growth and development.  Since that kind of assumed limitation is so common and crippling, and people with limited speech are so typically ignored, this philosophy is what all people should strive for.

It doesn\’t pretend the process will be easy, nor does it ignore biological, sensory, and processing differences.  These have their own chapters devoted to them, and while I could wish for much more to be said on the subject, it\’s a bit outside the scope of the book.

I can\’t stress enough how unusual Floortime\’s philosophy is.  Or how badly it\’s needed.  This is the therapy that should have been subsidized by insurance companies, not ABA.  Rather than teaching robotic compliance, it teaches proactive communication, self-regulation, and connection.  It recognizes that humans, all humans, are social and desire positive relationships with others.

It makes me wish, in all honesty, I\’d had the opportunity to benefit from this therapy.  As an autistic adult who is markedly leery about behavioral therapies, that\’s probably the highest compliment I can give.

I could probably continue showering Floortime and its creators in compliments and appreciation for some time, but there are some other things that should be said.

First, Floortime is not a \”follow directions, receive child with improved functioning\” sort of deal.  It\’s a significantly effortful, complicated, time-intensive method, which is why it took them 400 pages or so to explain it.  It requires you spend at least 15 minutes per session with the autistic person, and suggests 8 sessions a day.  As such, it is not a therapy that is easily practicable by every parent in the current world.  Single parents, or even two parents near or under the poverty line, may have difficulty finding the time and energy for the sessions.

The authors specifically state that interventions and therapy need to be built on a stable base: a healthy, safe environment with adequate food, shelter, and medical care (pg. 255).  In an ideal world, that would be true of every family.  In reality, it is not.

Money worries can strain spouse relationships, and communication issues may exist beyond the actual autistic person.  Family relationships in a household with an autistic person can be significantly unhealthy.  If the autistic person is to develop in a healthy way, family counseling may be required.  And of course, not all families can afford counseling.

Second, this book is not the most approachable for a busy parent.  The style of writing seems more akin to scientific writing than it does to plainspeak.  The word choice isn\’t overly elaborate, thankfully, but I found the writing dense and difficult to digest in large chunks.  The authors do not get to the point quickly or efficiently.  This is maybe understandable since they\’re trying to convey a philosophy and a state of mind, rather than simple facts or bullet points.

Finally, like basically every other \”here\’s this method to help autistic people!\” guide, this book is geared towards helping children.  Most references in the book speak about developmental levels and abilities typically involved in childhood, and the book stresses beginning Floortime as soon as possible.

However, Floortime can also be used with adults, and chapters 17 and 18 specifically talk about how that can be done.  They also share the results of a few cases where it has been done, and the positive results that followed.  So while I\’d personally appreciate more emphasis on it never being too late to start, the authors didn\’t entirely miss this point.

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