Pretending to be Normal: Living with Asperger Syndrome

Book Reviews

Single Subject Research: Applications inEducational and Clinical SettingsBy S. B. Richards, R. L. Taylor, R. Ramasamy & R. Y. Richards, Singular Publishing,

London. x þ 308 pages (pbk), ISBN 1 56593 799 6, 1999.

The need for a book providing concise guidance on how to plan and carry out studies

using single-subject design methodology is clear, judging by the lack of rigour that seems

to typify normal clinical practice. For example, how often do those of us working in

health or educational settings establish stable baselines or carry out meaningful follow-

ups? The argument that such procedures are arcane and timewasting, and best left to ‘the

researchers’ may be countered in two ways. Firstly, much good clinical practice never

makes it into the journals because of a lack of basic scientific rigour. However, what is

far more important is that it behoves us to ensure that our behavioural, counselling,

pharmacological and other interventions actually work. We need to carry out proper

measurements in order to establish this.

Of course, there have been previous attempts to outline single-subject research in a

readable manner, the volumes by Kazdin (1982) and Barlow & Hersen (1984) being

perhaps the best known. More recently, Morley (1996) has produced a very useful

chapter. So, does this new book by add to the existing works?

The authors state that their aim is to ‘provide the reader, who is presumably not yet an

expert on single subject research, with the information necessary to understand the

literature and develop a single subject research study in general’. They go on to stress the

importance of referring to the relevant literature before designing a specific study. In

terms of the proposed readership, ‘this book is primarily intended for those working in

educational/clinical settings’, including teachers, speech and language therapists. In

fact, most of the wealth of practical examples given throughout the book are from

educational settings, reflecting the authors’ affiliations to two centres of (special)

education in the USA.

Single Subject Research is divided into three unequal sections. The first, taking up the

first third of the book, is headed ‘Conducting Single Subject Research: Issues and

Procedures’. The four chapters in this section cover a wide range of complex topics.

The first chapter gives a potted history of behaviour analysis from Watson to Baer via

Skinner before explaining such concepts as dependent and independent variables, and

how to graph data. This may seem an over-ambitious undertaking in one chapter, but the

authors’ clear prose and systematic way of building up concepts piece by piece, as if in a

technical manual, is surprisingly effective. The comparative lack of references in the text

also helps the flow, although the authors do reiterate frequently the importance of

practitioners reviewing the relevant literature(s) before embarking upon a study.

Inevitably, this telescoping of highly technical subjects does lead to some difficulties.

For example, when discussing the importance of taking baseline measures, the statement

‘. . . the baseline may be shortened or skipped altogether when ethical treatment

demands so’ needs more explanation than is provided, given the risks inherent in

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# 2001 BILD Publications 155

intervening precipitously. Also, many of the paragraphs are rather long, presenting the

reader with daunting blocks of fairly technical language. However, the ‘Summary

Checklist’ at the end of each chapter does help with the learning of key concepts.

Chapter 2 (‘Methods for Changing Target Behaviors’) dashes through reinforcement

and punishment, and related topics in 25 pages, making a good stab at explaining

negative reinforcement along the way. Chapter 3 (‘Methods for Recording Behavior’)

outlines subjects such as time sampling and inter-rater reliability, and even provides

examples of ABC charts and data recording sheets. However, this is one chapter that

suffers slightly from a lack of reference to recent research since computerized observa-

tion packages and analogue assessment methodology are not mentioned.

Chapter 4 discusses reliability, validity and ethics, and rounds off a very useful —

albeit at times slightly breathless — guide to a wide range of topics relevant to single-

subject research.

The second section covers most of the rest of the book and consists of a systematic

examination of single-subject research designs. Of the eight chapters in this section, there

are two each (‘Overview’ and ‘Application’) for withdrawal (reversal) designs, multiple

baseline designs, alternating treatment designs and changing criterion designs.

The overview chapters clearly describe the types of single-subject design outlined

above. The fact that each of these chapters follows the same format — a discussion of the

‘mechanics’ of the design, followed by a list of its advantages and disadvantages, and

common adaptations of the design — facilitates comparison of different procedures.

These chapters each have a summary checklist, in the same manner as the chapters in

section 1. Important procedural and ethical issues (e.g. the usefulness of a B-A-B design

in terms of minimizing the need for a lengthy baseline phase) are not neglected.

The application chapters illustrate each of the designs by examining research papers

taken from a range of journals, investigating how and why a particular design was used

in each study, together with the limitations of the studies. This is a very neat means of

bringing to life the somewhat dry descriptions of research designs from the overview

chapters.

Section 2 seems more thorough and less rushed than section 1, although there is still

only limited examination of recent studies. It functions as a useful reference guide to

different types of single-subject design.

The third section (‘Analyzing Results from Single Subject Studies’) consists only of the

30-page final chapter, ‘Methods for Analyzing Data’. This marks a return to section 1 in

terms of the level of ambition of the chapter. It is split into three parts: visual analysis,

statistical analysis and qualitative analysis. The visual analysis part starts with a helpful

guide on how to interpret graphs, but brings into the discussion with little or no

explanation such terms as ‘split-middle line method’ and ‘logarithmic charts’. Readers

with no mathematical or statistical training may begin to struggle at this point. This is

likely to be even more the case with the seven pages devoted to statistical analysis,

which include a two-page discussion of time series analysis. By contrast, the section on

qualitative analysis is very helpful and full of recent references, as well as a case study

and advice on how to combine qualitative and quantitative analyses.

This book feels like three (connected) volumes. Section 1 is probably the most helpful

for practitioners and researchers new to single-subject research in that it summarizes

many of the key principles which need to be considered. As a bonus, it also provides

concise but clear discussions of complex topics such as reinforcement and inter-rater

reliability. Section 2 is more likely to be of use as a desk reference guide to different types

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# 2001 BILD Publications, Journal of Applied Research in Intellectual Disabilities, 14, 155–170

of single-subject design. Section 3 feels like a continuation of section 1, but overreaches

itself when trying to pack an examination of abstruse statistical techniques into a few

pages.

Single-Subject Research fills a gap in the market, despite its occasional signs of over-

ambition. It is more up to date and readable than the ‘classic’ texts mentioned earlier, and

goes into more detail than does the Morley (1996) chapter. The book is probably of most

value to clinical and educational psychologists, psychiatrists, and behaviour nurse

therapists who are interested in conducting small-scale research projects for publication

and/or bringing increased rigour to their everyday practice. It should be required

reading for students of any discipline who need to understand the principles and

practices of applied behaviour analysis or single-subject research methodology.

The sheer quantity of information that is packed into the book suggests that it is best

read as a companion to a course of study — rather than as a ‘self-instruction’ tool — so

that the concepts covered can be discussed and clarified with the help of a tutor or

supervisor. Also, as the authors themselves stress, all the topics covered have an

extensive and ever-increasing fund of published research that really needs to be referred

to before embarking upon single-subject research. However Single-Subject Research is

excellent as an introduction or revision tool.

References

Barlow D. H. & Hersen M. (1984) Single Case Experimental Designs, 2nd edn. Pergamon Press,Oxford.

Kazdin A. E. (1982) Single Case Research Designs: Methods for Clinical and Applied Settings.Oxford University Press, Oxford.

Morley S. (1996) Single-Subject Research. In: Behavioural and Mental Health Research, 2nd edn (edsG. Parry & F. N. Watts), (UK), Taylor & Francis, Hove, pp. 000– 000.

Cliff Hawkins

Therapy Services Team Leader, Shropshire’s Community and Mental Health Services

NHS Trust Telford, UK

Parents’ Education as Autism Therapists:Applied Behaviour Analysis in ContextEdited by M. Keenan, K. P. Kerr and K. Dillenburger, Jessica Kingsley Publishers,

London. Pages 177 (pbk), ISBN 185302 778 2, £13.95, 2000.

This book bears the title of a parent group, Parents’ Education as Autism Therapists

(PEAT), who are committed to making available education and support to parents

considering behavioural teaching for their children with autism. This Belfast-based

organization was formed by parents who attended a series of workshops in 1997 on

applying behavioural methods to treating their children, but discovered that there was

no ongoing statutory provision for this form of intervention. The aim of the present book

is to provide clear and practical information for parents and professionals so that they

can make informed choices about behavioural treatment for children with autism. The

chapters are contributed by specialists in applied behaviour analysis (ABA) and PEAT

Journal of Applied Research in Intellectual Disabilities 157


members, and provide an informative introduction to the practical application of the

principles of ABA.

In the first chapter, four PEAT members provide a clear explanation of the main

technical terms and procedures used in ABA, using examples of how these have been

applied in ongoing treatment programmes with their own children. Apart from where it

is necessary in order to explain technical principles, the language is jargon-free, and

because it is written by parents for parents, the approach is relevant and understanding

of the trials which they experience. Therefore, this chapter will provide those enquiring

into this area with an encouraging overview of how ABA treatment can be used

effectively to address the disabling effects of autism. Furthermore, it will encourage

parents to consider the possibility that they could take a major role in their children’s

treatment. This is likely to be a welcome element for many of those experiencing feelings

of frustration and powerlessness once their child has received a diagnosis of autism.

Nevertheless, the authors maintain a realistic tone in emphasizing that ABA treatment

does not promise a quick cure, but offers productive behavioural changes through hard

work, commitment and perseverance. This seems a timely reminder that ABA is not

to be counted among the catalogue of largely unsubstantiated ‘cures’ for autism which

have abounded over the past decade (e.g. see Howlin 1998).

The following two chapters are contributed by ABA specialists, and provide an

overview of the academic literature on ABA interventions with children with autism

and an introduction to the dynamics of functional analysis, respectively. The literature

background in Chapter 2 describes outcome studies from intensive behavioural pro-

grammes with groups of children (e.g. McEachin et al. 1993). These studies have

measured gains in IQ and language performance after the application of behavioural

treatment programmes. They have contributed substantially to establishing the cred-

ibility of ABA as an effective treatment for children with autism, particularly because the

behavioural gains which are defined as goals can be seen to translate into cognitive gains,

as measured by standardized instruments, after a substantial treatment programme has

been implemented. Perhaps more importantly from a parent’s perspective, the author

highlights the criteria which predict successful outcomes from behavioural programmes

and identifies parental involvement as an important element.

This chapter also considers some of the criticisms of ABA interventions which have

been voiced in non-ABA disciplines and addresses some of the ‘inaccurate’ conceptions.

Nevertheless, it might have been more appropriate to term these as ‘outdated’ rather

than inaccurate. Applied behaviour analysis intervention has evolved and developed

considerably since its early application to autism, and previously, some of the criticisms

outlined here were valid. For example, aversive methods were more prominent than

they are currently – these are now usually used as a last resort in conjunction with

reinforcement-based strategies to replace persistent, severe aberrant behaviours (e.g.

aggression and self-harm) with more productive behaviours (e.g. communication

strategies; see Matson et al. 1996). Such examples illustrate how ABA has developed

through a positive response to criticism from other disciplines and a commitment to

developing high standards of practice. Highlighting this would seem more helpful in

countering such criticisms where they still abound, particularly if these present an

obstacle to parents considering ABA intervention for their child.

That said, the practical focus of subsequent chapters provides a more tangible basis for

parents to evaluate the potential of ABA treatment for their children. Chapter 3 outlines

the dynamics of functional assessment and analysis briefly but clearly. A case example of



an intervention from assessment to application sets the parent role into context and

effectively demystifies the process of ABA intervention. The case study perspective is

then expanded in Chapter 4, which is contributed jointly by parents and ABA specialists.

This is the longest chapter, following in detail a series of 17 interventions over a one-year

period with a child (Colin) aged 3 years and 10 months at the start of treatment. A range

of procedures is described, tackling various problems identified in Colin’s development,

including development of play skills, interpersonal relationships, and language in

increasingly generalized and sophisticated repertoires. Apart from the practical aspects,

the account highlights some important features of this approach. Colin’s programme

focused on problems identified in assessment by an educational psychologist. This was

important because the aim here was to remove the obstacles to his integration in

mainstream education presented by his behaviour. Therefore, the programme was

not led by some arbitrary decision on which behaviours Colin should or should not

be displaying. Rather, it worked in tandem with other professional assessments and took

into account his identified needs.

A striking feature of the account of Colin’s programme (and of the accounts from

parents elsewhere in the book) is the sense of involvement and empowerment that the

PEAT parents express repeatedly. Their role in data collection, decision making and

intervention design evidently has endowed them with confidence, not just in coping

with their children’s autism, but also in taking a major role in shaping their future.

Nevertheless, the programmes are undeniably demanding and can be stressful for

parents. This is acknowledged by the parent contributors to this book, who point out

that ABA is not a ‘quick fix’ treatment and involves hard and intensive work over a long

period. The key here is the collaboration between parents and ABA specialists. Colin’s

programme was creative, sensitive to his needs and involved the whole family. Some-

times, but not always, the procedures were built into fun activities, but they were

always structured around behavioural principles under the guidance of behavioural

specialists. This is also apparent in the reports from other parents in Chapter 5, which

extends case descriptions to examples with other children with various levels of

intellectual functioning.

A large proportion of children with autism have some degree of concurrent learning

disability, and depending on the severity of this, integration into mainstream education

may not be possible for all, as it has been for Colin. However, the clear message here is

that ABA can offer improvements in functioning to enable children with autism to

develop to their individual potentials. There is no doubt that parents set themselves an

arduous route in committing themselves to this form of treatment for their children.

However, the confidence that they gain through their involvement in their child’s

treatment evidently enables them to cope with the rigorous demands of ABA interven-

tion. Therefore, this commitment could be considered less stressful than being compel-

led to accept and accommodate problem behaviours because a child has received a

diagnosis of autism, or to trawl through a catalogue of unsubstantiated ‘cures’ by trial

and error, in the hope that an effective one will be found. At the very least, this book

should provide parents with the basis for an informed choice in the matter. Ironically

though, as the authors acknowledge, this choice is more likely to be hindered by

the current lack of availability of behavioural teaching programmes in the education

system than by an absence of information. Nevertheless, this book takes a vital step

towards justifying and promoting more extensive use of ABA treatment for children

with autism.



References

Howlin P. (1998) Practitioner review: psychological and educational treatments for autism. Journal ofPsychology and Psychiatry 39, 307–322.

Matson J. L., Benavidez D. A., Stabinsky Compton L., Paclawskyj T. & Baglio C. (1996) Behavioraltreatment of autistic persons: a review of research from 1980 to the present. Research in Devel-opmental Disabilities 17, 433–465.

McEachin S. J., Smith T. & Lovaas O. I. (1993) Long-term outcomes for children with autism whoreceived early intensive behavioral treatment. American Journal of Mental Retardation 97(4),359–372.

Dr Deborah Carr

Welsh Centre for Learning Disabilities Applied Research Unit,

Meridian Court, North Road, Cardiff CF14 3BG, UK

Pretending to be Normal: Living withAsperger SyndromeLiane Holliday Willey, Jessica Kingsley Publishers, London. 141 pages (pbk),

ISBN 185302 749 9, £12.95, 1999.

Dr Liane Holliday Willey only recognized that she had Asperger syndrome when her

7-year-old daughter received this formal diagnosis. Dr Holliday Willey’s insight into her

own difficulties is a characteristic of Asperger syndrome. This quality helps to set people

with Asperger syndrome apart from others who fall into the wide-ranging category of

autistic spectrum disorder. For practitioners working with families, the capacity of an

individual family member to recognize, within themselves, that their life-long uncon-

ventional view of the world has stemmed from Asperger syndrome is a major step

towards developing coping strategies.

Therefore, this autobiography presents a valuable opportunity for practitioners to

sample the perceptions, experiences and learning strategies of a person with Asperger

syndrome. The fact that Liane has taught some of these strategies for learning to her

daughter also increases the relevance for practitioners. For Liane’s own parents, the

acknowledgement that their adult daughter now has a ‘diagnostic’ label has helped them

to come to terms with the apparently bizarre aspects of Liane’s earlier behaviours at

school, at home, and in a variety of other social settings, actions which set her apart from

her peers, and caused her parents much pain and bewilderment at the time.

Pretending to be Normal is readable, full of anecdotes, and has appendices which

contain learning and teaching strategies for people with Asperger syndrome, support

staff and employers. Dr Holliday Willey’s style of writing is similar to other best-selling

autobiographies by people with Asperger syndrome in that it is articulate and sometimes

painfully descriptive, but fortunately – unlike some other accounts – it is not overly

elaborate. Ultimately, the book has a positive message: the author is now a successful

academic and mother of three children who proves that people with Asperger syndrome

should value themselves for who they are – and so should we.

Hugh Morgan

West Midlands Autistic Society, UK



Community Care Practice and the Law,2nd ednMichael Mandelstam, Jessica Kingsley Publishers, London. 656 pages (pbk),

ISBN 185302 647 6, £27.50, 1999.

‘Community care’ did not exist as a legal subject a decade ago, and the old legislation that

now forms its substance – in particular, the National Assistance Act 1948 – seldom

featured in the law reports. Little did I think when I included a chapter with this name in

my book Mental Handicap and the Law in 1992 that there would be a plethora of books on

the subject and frequent appeal cases in the highest courts involving the interpretation of

this legislation before the end of the millennium. There has always been care in the

community, but the formal policy of ‘community care’ was only introduced from April

1993. At best, it means providing individuals with the support and care which they need

rather than expecting them to manage with whatever services happen to be available. In

reality, lack of resources on the part of local authorities has dominated provision and this

has become fertile ground for lawyers, with the needy individual all too often becoming

a pawn in the funding game. At worst, community care has become crisis care.

There has been a danger that books on community care law would concentrate too

much on the difficult legal issues, and overlook all the good practice and worthwhile

provision which are taking place throughout the country. This second edition of Michael

Mandelstam’s established book does not fall into this trap and gives a well-balanced

picture of the new regime, including the policy framework and legal climate in which it

operates. The title, Community Care Practice and the Law, sends out the right message. The

book is aimed at planners, managers, legal practitioners, social workers, students and

users of services – the widest possible audience – and is well targeted, but it does not

make for light reading. The author is academically qualified as a lawyer and medical

historian, but has also worked for the Disabled Living Foundation and Social Services

Inspectorate. Therefore, he has hands-on experience of care provision, even though he

lacks inside knowledge of the legal system. This balance shows in Community Care

Practice and the Law, although the book is not to be underestimated as a legal textbook.

Apart from interpreting community care as including health care provision, the author

sticks rigidly to his chosen title, and does not trespass into such linked areas as social

security benefits or financial management for those who lack capacity. Therefore, further

reading material will be required by those who wish to understand the overall needs of

people with mental and physical disabilities (including the elderly), and how these needs

are met in our society under our legal system. The author has clearly gone to great

lengths to obtain material from managers, practitioners, voluntary organizations and

colleagues as to what is going on in practice, and frequently adopts a ‘user up’ rather

than ‘law down’ approach. This essentially practical approach is ideal for care profes-

sionals and users of services, and will be welcomed by many legal practitioners when

facing problems presented by clients.

Unlike some more expensive volumes which disappointingly contain more statutory

material than original text, this book is all the author’s own work and it is written in plain

English, and therefore, is readily digestible. Quotations are woven into the text and the

material is well structured. After a useful overview with checklists in Part I, there are

three further parts, each divided into chapters. Under each main heading within these



chapters are the subheadings ‘Extracts’, in which legislation, policy guidance and

practice guidance are set out, and ‘Discussion’, in which practical issues and case-

law are considered under lesser subheadings. It works well.

Part II is entitled ‘Community Care Assessment and Service Provision’, but as one

would expect, includes residential and nursing home care. It also extends to charges,

dealing separately with residential and non-residential services. Human rights and

disability discrimination are dealt with superficially in short sections within the rather

uncomfortable chapter on ‘Aspects of Assessment and Service Provision’, whereas their

implications potentially extend throughout the entirety of the material. The final chapter

on ‘Joint Working, Information and Planning’ is valuable, not least because this area of

potential difficulty is sometimes overlooked.

Part III, entitled ‘Health Services and Home Adaptations’, is comparatively short.

Chapters deal with National Health Service provision (including charges), continuing

care (including hospital discharges), and as one might expect from the heading, home

adaptations, although these do not generally concern health authorities!

Part IV, entitled ‘Disputes, Local Ombudsman Investigations and Legal Judgements

(Digests of Cases)’, is as awkward as its title. It starts with a chapter on disputes and

remedies that is comprehensive in coverage, but superficial in regard to procedural

matters (especially court proceedings), no doubt reflecting the background of the author.

This may satisfy most readers, but will leave the practising lawyer looking for more.

Comprehensive digests of local ombudsmen’s reports and legal judgements follow in

further chapters (the book is almost worth buying for these alone), but the digests would

logically be treated as appendices because they are of more significance as regards

substantive law than mere procedure.

There are no tables, and the alternative ‘References’ (which reassuringly indicate how

well researched this book is) are a poor substitute since they do not give page numbers or

include the many cases to which the author refers. Cases are merely named when

referred to throughout the text (there are no footnotes), but can then usually be found in

the ‘Digest of Cases’, although, unhelpfully, only one reference to law reports is given for

each and there is no cross-reference to the pages where the case is considered. The index

appears adequate, but the absence of traditional tables and the fact that the contents

pages only identify chapters make navigation through this book difficult, a problem that

is only compensated for by the list of items covered at the start of each chapter. These are

significant failings which I hope will be remedied in the next edition since they devalue

the book to practising lawyers who would otherwise benefit from the comprehensive

and practical coverage of this subject.

Inevitably, the material is already out of date with respect to some developing areas,

but this does not detract from the clear understanding that all readers will achieve of the

brave new world of ‘community care’. This textbook is ideal for those seeking maximum

information at minimum cost, whether as care professionals, users of services or lawyers.

Community Care Practice and the Law represents exceptional value for money (at least by

lawyer’s standards) and should not be overlooked by those more concerned with the law

than the practice of community care simply because it is not marketed by one of the

leading law publishers. A mere decade ago, a book of this nature could not have been

imagined, which demonstrates that needs are at least recognized now, even if provision

remains inadequate.

Gordon Ashton

District Judge, UK



Mind and Body Spaces: Geographies ofIllness, Impairment and DisabilityEdited by Ruth Butler & Hester Parr, Routledge, London.

xiiþ 307 pages (hbk/pbk), ISBN 0-415-17902-5/0-415-17903-3, £60.00/£19.99, 1999.

This collection brings together a number of authors from around the world, who explore

the geography (or geographies) of illness, disability and impairment. The essays range

from theoretical to more empirically based studies, and it would not seem at all trite or

exaggerated to say that they mark the cutting edge of geography and disability studies.

The papers are extremely heterogeneous in their approach. Some succeed by bringing

disability into more established areas of geographical enquiry (e.g. the city), whilst others

bring the particular insights and contributions of geography to bear on established

disability issues such as political activism.

For those of us who are not familiar with geography as a discipline and perhaps more

accustomed to the more familiar names in disability studies and intellectual disability

from the UK or elsewhere, Mind and Body Spaces will undoubtedly present a number of

new authors and interesting new lines of enquiry. Indeed, this book has helped to further

reinforce a growing awareness on my own part of a general ignorance of the extent to

which geography has managed to establish itself at the forefront of theoretical and

empirical research into social exclusion generally. For anyone else wondering whether

this is a book for geographers only, the answer is a definite ‘no’. This work has a great

deal to offer researchers, theorists, activists and practitioners working in the disability

field in the broadest sense.

As the title suggests, the work takes in a very broad range of conditions, issues and

perspectives. Contributions range from studies of the implications for disability of Le

Corbusier’s theories of architecture and environmental planning to disability and the gay

community, moral crusades in the US on intemperance, and children caring for disabled

parents. There are papers on intellectual disability, mental illness and chronic pain, as

well as gender, activism, housing, rural issues and employment.

Of the many new insights which Mind and Body Spaces will hold for most readers,

especially those of us not familiar with recent directions in the geography of disability,

one of the most stimulating is the way in which it poses a number of very familiar issues

in unfamiliar ways. For example, Park & Radford take a number of crucial issues in

intellectual disability and present them in terms of spatiality: ‘Where do people with

intellectual impairments fit into society?’; ‘Where do they live?’; ‘Should they work, and

if so, where?’; ‘Is it worthwhile educating them, and if so, where and how?’; ‘Should they

be allowed to have children?’; and ‘Are they capable of exercising proper control over

their own lives, and if so, in what kinds of environments?’ Nothing in this list is likely to

strike an unfamiliar chord with anyone with even a passing acquaintance with the field

of intellectual disability. What may seem less familiar is for spatial distribution, move-

ment and management to be given as primary organizing concepts in analysis. Never-

theless, when presented with this kind of analysis, it is difficult to avoid thinking, ‘What

else could it have been that we have been considering for so long if not space and its

governance?’

The use of space for social governance is also central to Imrie’s paper on Le Corbusier.

As with several other papers, although more so, this contribution presents a



largely unfamiliar subject matter in a thoroughly fascinating and accessible way.

In this work, the development of a rational system of architecture and environ-

mental design in the pursuit of urban and social perfection is linked directly to the

quest for and promotion of the perfect body, and thus, the radical exclusion of the

disabled body.

By contrast, a number of papers, whilst dealing with issues in a thoughtful manner and

presenting interesting data, do not seem obviously ‘geographical’, i.e. in the sense of

providing an approach or analysis that differs substantially from something that might

be offered by other disciplines such as sociology, history or social policy (e.g. Stables &

Smith’s study of young carers or Hall’s work on employment and disability). On the one

hand, this blurring of disciplinary divisions is welcome and can only help produce

interesting new collaborations and cross-fertilization. At the same time, given that the

title seems to promise it, it does not seem entirely unwarranted to ask what a ‘geography’

of illness, impairment and disability might offer that a ‘sociology’, for example, could

not. Two possible responses to this question might be made. First, Mind and

Body Spaces deals with the question of how space has become internalized into the

body. In other words, the push from the study of the body over the past few decades

has been to spatialize the body itself and this is reflected in the very title of this

book. Space is no longer merely that which lies beyond the boundaries of the body.

Thus, geography comes to penetrate new areas such as the impairment and illness of

the body, and even the mind. The second response might be that, even though in many

cases the areas of overlap may be larger than those in which a more specialized expertise

or conceptual framework is evident, there are times when making a particular virtue

of even subtle differences in perspective can only help to stimulate fresh thinking.

On these counts Mind and Body Spaces certainly does more than enough to sustain its

subtitle.

One of the most immediate and refreshing aspects of the contributions to this book is

that they are not dominated by any single strand of thought on disability issues. In

particular, the work shows greater willingness to theorize disability than has generally

seemed possible within the strict confines of the social model, which is surprisingly little

in evidence. Mind and Body Spaces also gives far greater prominence to the body, and its

‘impairments’ and experiences than the social model, which has frequently maintained a

certain scepticism towards these matters. Indeed, the kind of clear mind–body–society

divisions on which so much of the social model rests are called into extreme doubt by

these essays. In its general willingness to engage with more sophisticated social theory,

the book is probably closer in approach to the work of authors such as Tom Shakespeare

and Mairian Corker than most of the other prominent figures in disability studies, at least

in the UK.

However, the work of Lennard Davis is curiously absent, and his work on the

construction of ‘normalcy’ receives only two mentions. This seems particularly unfor-

tunate since a number of papers could have made use of his work on the construction of

normality in relation to bodies and minds. In Imrie’s case, the transition from the ideal of

the perfect body in antiquity to the normal body today might have strengthened an

otherwise excellent paper.

If the strength of edited texts of this kind is the way in which they can cover a range of

perspectives and topics, then the drawbacks are usually variability in the quality of

contributions and the relative underdevelopment of any single issue. With regard to the

first issue, it must be said that the overall quality is consistently high, and although some



papers still manage to stand out as particularly good, none comes across as weak.

Perhaps the second point does raise more of a question. Quite a few of the papers,

especially the better ones, almost seem to demand books of their own, and whilst it may

seem rather unfair to criticize a book for not being or achieving what it does not set out to

be, it is one of the frustrating aspects of the work. A full theoretical study of disability and

the geography of social exclusion is still to be written! More seriously, one or two of the

papers seem in need of greater theoretical development if their arguments and promise

are to hit their mark with real force. For example, what we are confronted with in Park &

Radford’s study of ‘mental deficiency asylums’ is more like a fascinating hypothesis in

need of further study and exposition. That said, simply opening new lines of enquiry is of

tremendous value in itself.

In conclusion, Mind and Body Spaces is sure to prove an invaluable addition to disability

studies. The contributions are of a uniformly high standard, well-written and make the

book a genuine pleasure to read. Its coverage will help stimulate further analysis along

new lines in a wide range of areas, as well as helping to reinforce the central position of

geography in the study of disability and social exclusion. This book will prove an

invaluable contribution to anyone interested in these issues.

Dr Murray K. Simpson

Department of Social Work, University of Dundee, Dundee, UK

Attention Deficit Hyperactivity Disorder(ADHD): Research Practice and OpinionEdited by P. Cooper & K. Bilton, Whurr Publishers, London. ixþ 255 pages (pbk),

ISBN 186156108 3, £19.50, 1999.

As readers will know, the term attention deficit hyperactivity disorder (ADHD) origi-

nated in the USA, and refers to individuals whose behaviour is so inattentive, impulsive

and overactive as to warrant very serious concern. It is a medical category that is defined

in terms of the criteria published in the fourth edition of the Diagnostic and Statistical

Manual of Mental Disorders (DSM-IV; APA 1994). The DSM-IV allows differential

diagnosis on the basis of the balance of symptoms of inattention, impulsiveness and

overactivity. All will be present in most cases. Where the criteria for attention problems

but not impulsive/overactive problems are met, then the subtype is labelled as ADHD

predominantly inattentive type. Conversely, where attentional problems are not noted,

ADHD predominantly hyperactive-impulsive type can be diagnosed. The category of

ADHD can be considered an umbrella term, referring to a heterogeneous group of

individuals. Some researchers have indeed suggested that those with attentional pro-

blems alone represent a different ‘category’ requiring different explanatory hypotheses.

Attention Deficit Hyperactivity Disorder considers research, practice and opinion from a

number of standpoints, including chapters written by lay people, medical practitioners,

teachers and university lecturers. The book is divided into three parts: ‘Understanding

ADHD’ (four chapters), ‘Supporting People with ADHD’ (seven chapters) and ‘ADHD

in practice’ (three chapters).



The first part opens with a chapter written by one of the editors, Paul Cooper, and

briefly outlines theories of causation under the headings of cognitive, neuro-imaging and

genetic research. The brevity precludes any mention of debates among researchers, and

in particular, description and evaluation of research studies which have led to particular

explanatory stances. While this chapter is not for readers wishing for a detailed know-

ledge of the research basis and controversies underpinning the concept of ADHD, one

of its purposes is to mention the limitations of medical concepts which may assume too

readily that causes are located exclusively within the individual. This leads to the

author’s biopsychosocial perspective requiring a holistic approach to ADHD – a theme

underpinning most of the contributions. Where one would have expected an outline of

the rationale of the contents to appear as in an initial introduction to the whole book,

unusually, this chapter ends with that information. Presumably the editors felt that the

outline would only make sense after the concept of ADHD had been explored in the first

instance.

The following two chapters are written, respectively, by the mother and the brother

of ‘Tom’, and in the next, ‘Joseph’ describes the pain of having ADHD. Together,

these vivid and moving personal accounts remind the reader of the ‘emotional under-

standing’ of ADHD that needs to accompany any objective debates about the nature,

identification and treatment of the disorder. The accounts illustrate the severity

and persistence of the problems of ADHD, and their effects on personal relationships

and educational and occupational progress. They demonstrate that ADHD is a

serious lifelong disability that can be ameliorated but not cured, and thus, the contribu-

tions indirectly warn against widespread diagnosis of ADHD, as appears now to be

happening in the USA, that may inadvertently belittle the suffering of those with

severe ADHD.

The first chapter of Part 2 by Detweiler, Hicks & Hicks describes a ‘multimodal’

approach involving a team of professionals in a private clinic in London. The tone of the

chapter conveys a sense of certainty that may be premature in the light of present

knowledge, and an assumption that all kinds of aspects of ADHD can be ‘measured’ with

reliability and validity. Nevertheless, the detail and thoroughness of the work is

impressive and the educational arrangements in their segregated small class provide

examples of practice which may be modified and adopted in mainstream. The second

chapter by Kewley, also from the standpoint of a privately run centre, focuses on the role

of medication as a ‘window of opportunity’ in enabling environmental approaches to

intervention to take place. The chapter clearly outlines the effects and side-effects of

psychostimulant medication.

As an educational practitioner familiar with social, psychological and educational

arguments, I found the next two chapters both original and fascinating. They are written

by Joan Kinder, a consultant paediatrician, and argue strongly against an over-ready use

of stimulant drugs. Instead, the chapters evaluate dietary and nutritional factors, and a

number of holistic complementary therapies which represent alternative approaches to

medication not yet accepted by orthodox medicine. The concept of food intolerance is

explained and there is reference to double-blind placebo-controlled trials showing that

children can be helped by diet. It is also emphasized that children should not be put on

restrictive diets without medical and dietetic supervision. The occurrence of excessive

thirst is mentioned several times as an important symptom of both allergies and dietary

deficiencies, which are described in detail in subsequent sections. I wonder whether my

interest in this chapter has been partly fuelled by more general trends in society, where



many of us have become enthusiastic about organically grown food, and knowledgeable

about gluten- or lactose-free diets.

The second of Joan Kinder’s chapters provides clear descriptions of a number of

complementary therapies: acupuncture, aromatherapy, Bach flower therapy, Bowen

therapy, colour therapy, herbal medicine, homeopathy, osteopathy, reflex-inhibition-

brushing, reflexology and speech therapy. Bearing in mind that no research evidence is

mentioned, the chapter provides intriguing and informative reading. Both of the

chapters end with useful lists of organizations and their contact addresses. These lists

also remind the reader that new initiatives and possibilities have become ‘big business’

not only in medicine but also in education, and that it can be difficult for consumers to

evaluate their effectiveness.

While these two chapters have focused on problems which lie within the individual

rather than an examination of overall social and educational contexts, the balance is

corrected in the subsequent three chapters. First, Paul Cooper argues that ADHD can and

should be met within a teaching and learning framework that is appropriate for all

children. All children, and particularly those with ADHD, benefit from clear and

predictable routines and structures. Then Egide Royer explains the principles of

cognitive behaviour modification and provides useful illustrations of the approach in

practice. However, the review of previous studies concludes that these approaches have

not consistently demonstrated positive effects in addressing ADHD. Finally, Jane Lovey

considers the teacher’s role and strategies in the classroom in relation to case examples of

children whom she has taught.

The last three chapters of the book describe research undertaken by their authors.

Lesley Hughes investigates perceptions of ADHD through interviews with nine medical

and educational professionals, and proposes a collaborative problem-solving approach.

Samuel Daniel and Paul Cooper report teachers’ classroom strategies for dealing with

ADHD consisting of positive reinforcement, student instruction, mild reprimand, seat-

ing arrangements, grouping, pedagogical strategies, time-out and ignoring. Finally, Paul

Cooper and Trevor Shea interview 16 young people diagnosed as having ADHD, and

conclude that the students perceive the condition in terms of biological determinism and

experience ADHD as both debilitating and stigmatizing.

As stated in the first chapter, the aim of Attention Deficit Hyperactivity Disorder is not to

convince the reader that a single view of ADHD is most valid, but to provide information

and insights which readers can use to inform their own thinking about the issues of

ADHD. In my view, the book certainly achieves this aim. Nevertheless, something of a

‘single view’ can be distilled from the different perspectives. All the contributors write

with commitment and a sense of mission, and do not question or debate conceptualiza-

tions of ADHD as a mental disorder. All subscribe directly or indirectly to a biopsy-

chosocial perspective. All – even those given the task of describing pharmaceutical

intervention – consider stimulant medication to be an adjunct, a window of opportunity,

for enabling social and educational interventions to take place. The exception is perhaps

Joan Kinder, but even she would prescribe in extreme cases when dietary alternatives

have been exhausted.

However, none of the chapters take the broader sociological view represented by

authors such as DeGrandpre (1999), who argues convincingly that ADHD, and its

treatment with the psycho-stimulant Ritalin, is a phenomenon created by American

society. It is the ‘rapid-fire culture’ and pace of life which yield an insatiable demand for

constant stimulation, and therefore, it is not surprising that some children develop



restless minds and impulsive personalities. The bouquet of perspectives in Attention

Deficit Hyperactivity Disorder would have been enhanced if a chapter on this subject had

also been included.

Dr Rea Reason

School of Education, University of Manchester, Manchester, UK

References

American Psychiatric Association (APA) (1994) Diagnostic and Statistical Manual of Mental Disorders,4th edn. American Psychiatric Association, Washington, DC.

DeGrandpre R. (1999) Ritalin Nation. Norton, New York, NY.

Children’s Language and CommunicationDifficulties: Understanding,Identification and InterventionJ. Dockrell and D. Messer, Cassell Education, London. Pp. xiþ 180 (hbk),

ISBN: 0304 33657 2, £15.99, 1999.

The expressed aim of Dockrell & Messer is to describe research into and theories of

language development, and then apply this information to children with a range of

language impairments. This intention presents the authors with a serious challenge in a

book of only 180 pages!

The target audience for Children’s Language and Communication Difficulties: Under-

standing, Identification and Intervention is broad: ‘professionals, teachers and parents’ who

are interested in current research and theory on language acquisition, children with

language and communication difficulties, and the principles which should inform

remediation of these difficulties. Sadly, this means that the book may not be seen to

be of great relevance to the majority of readers of this Journal. However, I would suggest

that the authors are underselling themselves. Children’s Language and Communication

Difficulties will also be useful to students across a range of disciplines; for example,

education, speech and language therapy, psychology, and nursing. It also discusses

issues to do with assessment and intervention which have much wider relevance than

children with language and communication difficulties.

The references to published research and theory, and the use of technical terms, albeit

with explanation, place considerable demands on a non-specialist readership. However,

the book is well written and sufficiently engaging for people genuinely interested in the

topic to find their efforts amply rewarded.

Children’s Language and Communication Difficulties covers similar ground to two earlier

books aimed at the non-specialist, Crystal’s Child Language Learning and Linguistics and

Beveridge & Conti-Ramsden’s Children with Language Disabilities. The most recent

editions of each of these books came out in 1987. The present volume is a more

demanding read than either of the above, but it includes greater reference to published

research and a more contemporary account of language acquisition. As such, I would



hope that it finds its way into public libraries, as well as professional and academic

settings.

The book is ordered in a logical and helpful way. The first two chapters address the

sequence of typical language development and the processes which underpin that

sequence according to contemporary research. Despite the brevity of these chapters,

the authors manage to include discussions of some controversial issues, such as cross-

cultural variation in adults’ linguistic interaction with young children. Language

learning beyond 3–4 years of age is addressed only briefly, and the discussion of the

relationship between oral and written language is sketchy. This limits the usefulness of

this volume for mainstream school teachers. In contrast, the three pages on connectionist

networks serve as a genuinely accessible introduction to a complex topic.

Chapters 3–6 cover language impairments in children with a specific language

impairment, those with intellectual disabilities, children reared in isolation, and those

with visual impairment and hearing impairment, respectively.

Chapter 3 contains an informative account of specific language impairment and its

implications that would make a valuable introduction to the issues for teachers or

parents. The interrelationship between language difficulties and more generalized delay

is picked up in Chapter 4, which includes a whirlwind guide to intellectual disability.

Unfortunately, this is rather too focused on specific syndromes, with quite detailed

consideration of some very low-incidence impairments such as autism and Williams

syndrome. In contrast, there is nothing on communication in people with profound

intellectual disability. However, the critical discussion on Theory of Mind will be

helpful to many readers.

Chapter 5 includes both sensory deprivation and visual impairment. The content

about the former is interesting and used as a context for discussing the existence of a

critical period for language learning. However, it is unlikely to be of practical relevance

to many readers. The section on visual impairment is systematic and provides a good

range additional references.

As might be expected, Chapter 6, on hearing impairment, is considerably more

detailed. There are a few minor inaccuracies, such as the equating of otitis media with

glue ear. Rather brief reference is made Deaf culture and sign language.

Chapter 7 contains a very strong account of the principles and process of the

assessment of language and communication. The importance of assessment in giving

a detailed understanding of an individual’s strengths and difficulties is very well argued.

Chapter 8, on intervention, is a little less satisfying. Perhaps it is just harder to talk

about intervention in the abstract. However, there is valuable information in this wide-

ranging chapter, including reference to the thorny topic of effectiveness.

The final chapter brings together many of the issues raised in previous chapters. One of

the real strengths of Children’s Language and Communication Difficulties is that the authors

are not afraid to express uncertainties and unresolved controversies. This might make for

uncomfortable reading for those in search of easy answers, but language and commu-

nication are not simple topics. The complexities cannot be avoided, and after a challen-

ging debate, the reader is at least provided with a good range of further reading to follow

up the issues which grab their attention.

Perhaps it is churlish to criticize the authors of such a useful book for what they have

omitted, but what are reviews for? Given that the title of the book includes the word

‘communication’, it is surprising how little coverage there is of pragmatics, the rule

system covering the communicative use of language. It was also very surprising to find



no reference to the language and communication difficulties which can arise from severe

physical impairments such as cerebral palsy.

This book is rather restricted in the whole area of non-verbal communication. There

are only very limited considerations of sign languages as the natural languages of deaf

communities, and of the high- or light-tech augmentative and alternative communica-

tion systems used by people with severe physical impairments, for example. For readers

of this Journal, there is relatively little on the communication of people with profound

intellectual disabilities, and the associated debates over intentionality and ascription of

meaning.

Since the majority of the world’s population acquire more than one language as a

matter of course, bi- and multilingualism cannot be regarded as ‘difficulties’ in them-

selves. However, it was surprising that the implications of bilingualism for assessment

and intervention were not mentioned.

However, it would be unfair to focus only on what Children’s Language and Commu-

nication Difficulties leaves out since there is a great quantity of information and critical

discussion in a mere 180 pages. I found it a stimulating and enjoyable book. I just wish

there had been more of it!

Juliet Goldbart

Department of Psychology and Speech Pathology, Manchester Metropolitan University,

Manchester, UK



Pretending to be Normal: Living with Asperger Syndrome

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