By Mohammad Ghaziuddin (2005) Jessica Kingsley Publishers
Leaping in at the deep end is something I do occasionally. Recently I committed to doing what I do – deliver mental health awareness and first aid courses; this time to the staff and support workers at a residential college specialising in teaching young people (16+) affected by Asperger syndrome and high functioning autism.
Now, I have to admit, my knowledge of Pervasive Developmental Disorders including the autistic spectrum, was brief, from work I did years ago with people affected by ADHD. Back then I saw almost every condition including ADHD due to the generally inadequate support of childhood conditions where I was living. So knowing I needed to brush up my knowledge I asked my LinkedIn network for recommendations of specialists I could approach for advice on the overlap of mental health conditions and pervasive developmental disorders (PDD’s). Following a couple of recommendations, I bought a copy of Ghaziuddin’s book. Quite frankly, for the layperson/psychotherapist and possibly as an introduction to the subject for trainee psychologists/psychiatrists, I think this book is brilliant.
The main focus is autism, but once you understand autism the other PDD’s fall into place by exception and their uniquely different traits. For example, people diagnosed with Asperger syndrome are generally communicative with a “normal” or higher IQ; those with autism are non-communicative and can have a low IQ; those with high functioning autism are also non-communicative and have a normal or high IQ.
For each PDD he explains what it is, it’s historical background and prevalence, causes, clinical features, diagnosis, conditions it may be confused with (and why) and what treatments/therapies or interventions are applicable. Each chapter has an extensive reference list for further study.
There follows a chapter on medical conditions in autism, something I had not previously thought about, but which make a significant impact on an affected individual and their family when combined with PDD’s. Such medical conditions include mental retardation and seizures (or forms of epilepsy) and a whole range of specific conditions including gene disorders (Fragile X and Down syndrome) and disorders caused by viruses (cytomegalovirus, herpes, etc).
Next Ghaziuddin covers general psychiatric disorders that occur in people affected by PDD’s. He writes “All psychiatric disorders cause distress, and affect the life of the individual in a negative way.” At this point, I was gaining an understanding of just how complicated PDD’s can be with multiple conditions affecting an individual (the PDD, the medical and the psychiatric). He has an insightful diagram in this section that shows how the comorbidities overlap each other. This explains why no two cases present the same and why treatment programmes must be individualised to address the individual’s particular needs. It also explains why getting a diagnosis can be challenging and why treatment may be a complicated matter posing the question of what to treat first (and why). We must also remember that no individual is alone; there are a family and a community of people around each one that may need support too.
Useful case studies are included with many of the explanations of the conditions throughout the book which help the reader gain understanding of them. A whole chapter addresses ADHD and PDD. Further chapters are dedicated to depression and mood disorders; anxiety disorders; Schizophrenia and psychotic disorders; tic disorders and Tourette syndrome and “other” psychiatric disorders.
The issue of violence is addressed late in the book but we are challenged to think about the definition of violence (should it include verbal threats or just behaviour resulting in a criminal conviction?). The role of the media and the perceptions it fosters are another issue – are people with PDD more likely to be the offenders or the victims of violence? The assessment and treatment of violent behaviour need to be handled carefully. Think about how frustrating it must be to be unable to communicate what your needs are and to not have them met?
The final chapter is a long-term view – the task ahead. Ghaziuddin quite rightly points out that “Carrying a diagnosis of autism and Asperger syndrome does not confer immunity against other medical or psychiatric disorders.” Whilst research into the mental health conditions affecting people with PDD’s is in its infancy and the need for early diagnosis and treatment is important, getting that diagnosis and treatment is another challenge complicated further where there are overlapping conditions. Hovering in the background is the family of the affected person and the attendant discrimination applied against any mental health disorder in the media and often by the community at large. The need to disseminate facts not fantasy about PDD’s and all mental health conditions will be one small change in making society more supportive of all such conditions.
You can order your own copy of this book here.