A Positive Approach to Autism by Stella Waterhouse. Jessica Kingsley Publishers, 2000.

Foreword by Donna Williams. 382 pages. Includes glossary, appendices, useful addresses, bibliography. ISBN 1 85302 808 8 paperback.

Positive? A word to use about Autism? For most people, Autism seems a tragic and unmitigated disaster. We may prepare ourselves for all the responsibilities of ordinary parenthood but Autism can turn family life upside down and inside out. Non-family caregivers usually find Autism to be the most challenging condition they encounter.

Stella Waterhouse’s book is positive, in several ways. For persons with Autism and their families, it is refreshing to have so many of the symptoms taken seriously–the multifarious “little things” they experience or observe which may be disregarded by professionals who see only the evidence for their favourite hypothesis or treatment. As Donna Williams notes in her foreword to the book, it is unusual for a professional to come so close to an autistic perspective and to have such a holistic approach to understanding Autism. Donna writes that “Stella takes the loose ends of sensory and perceptual, cognitive, anxiety, self-control and biochemistry problems, tracing them back to the spool from which these seemingly disconnected tangles came.”

Stella Waterhouse taught young children with learning disabilities and spent ten years working with emotionally disturbed adolescent boys. She then worked in a community providing residential care and training to adults and teenagers with Autism, as first as Senior Care Officer and later as Deputy Principal. Concerned that much of the current literature is unduly pessimistic and that several fallacies should be challenged, she embarked on a ten-year period of research for this book, a process that she likens to detection. In place of the common fallacies about Autism, she set out to prove that:

  • “The vast majority of people with Autism are of potentially normal intelligence and all are educable if provided with the right kind of help;
  • “They begin life with all the potential for feelings that “normal” people have, and do want to communicate even though they may have difficulties in doing so in a “normal” understandable manner;
  • “Most parents are warm and caring people, coping with immense difficulties which are frequently compounded by unthinking attitudes.”

The author also wanted to speak for those unable to speak for themselves. She did not foresee where her investigation of the puzzle of Autism – “one of the most awful handicaps presently known to man” – would lead her.

A Positive Approach has major chapters on Theories and Ideas, Analysis and Discussion, Hypotheses, Diagnosis, Treatment, and Implications. The most important theories and ideas include emotional deprivation, communication and relationships, brain damage or dysfunction, abnormal sensory perceptions, visual perception problems, auditory problems, dyslexia, metabolic disorders and allergies, attention deficit hyperactivity disorder, and anxiety. Conditions which resemble or may co-occur with Autism are also discussed (such as obsessive compulsive disorder, Tourette’s syndrome, schizophrenia, fragile X chromosome, tuberous sclerosis, rubella, Rett’s disease, Landau Kleffner syndrome, epilepsy, and phenylketonuria) and the role of multiple vaccines.

At first, the author could find that the only common thread among all the ideas of Autism was anxiety. Through her analysis and discussion, she finds four factors are combined in most people with Autism and Asperger’s syndrome.

  • A faulty digestive system which affects the functioning of the brain, causing normal development to be disrupted.
  • Neurodevelopmental delay which severely disrupts the perceptual system and effectively hampers the child’s interaction with other people and bars him from exploring his environment and thus reduces his ability to learn from or understand the world around him.
  • Severe and ongoing stress.
  • Chronic and acute anxiety.

In Autism these things combine to trigger a fifth aspect of the problem:

  • Withdrawal and/or obsessive/compulsive behaviours that are the symptoms we know as Autism, which further detach the child from “normal” childhood experiences. But the idea of “aloneness” which led to the use of “Autism” as the name of this disorder is misleading. Perceptual problems and anxiety are far more important.

People with classic Autism and Asperger’s syndrome are genetically predisposed to fragility in the central nervous system that can develop into various anxiety-related disorders if given a particular set of circumstances.

Waterhouse suggests that there are several different Autisms, and that all should be considered as part of the continuum of developmental disorders. Each form of Autism needs specific types of treatment. Treatment should be implemented as early as possible. But this does not mean that we should give up hope for a person who has reached adolescence or adulthood. She has seen great strides made by adults who have undergone dietary and/or sensory treatments. Specific treatments are discussed–as to whether they treat and rectify the problem, reduce or alleviate the problem, or may enable the person to compensate for difficulties. Whatever treatments are found likely to be helpful, they must be offered and implemented with great sensitivity.

North Americans could learn more about the alternative, holistic approach pioneered by Donna Williams, that offers advice about metabolic, perceptual and processing problems in effective and inexpensive ways. The author also recommends that every child and adult with Autism be assessed professionally so that digestive problems, intestinal/bowel disease and/or food intolerances can either be eliminated or the necessary treatment implemented. She discusses vitamins, minerals and homeopathy; reflex inhibition; sensory integration (including sight, sound, touch); holding therapy; behaviour modification training; the importance of structure and consistency; psychotherapy and play therapy; medication; various forms of therapy (art, relaxation. music, massage); and specific programes such as the Option Institute, Giant Steps Centre, and Higashi School. In considering communication, she puts special emphasis on Facilitated Communicating (FC) which she feels to be valid and useful when combined with knowledge and understanding.

Waterhouse only sketches some of the implications of her positive approach to Autism. With her British viewpoint and professional experience, she may understate the “unthinking attitudes” and lack of resources that beset families in Canada, especially if we are concerned with adults on the Autism spectrum. But we applaud all the open-minded research and thought she has put into A Positive Approach to Autism.