Introduction

A Call from the Trenches

From time to time throughout my career working with special needs and typically developing children, I would be offered an administrative, consultative or teaching position. Though sometimes tempted, I usually declined, explaining that I preferred to continue working in the trenches: with the children, grappling with their difficulties, attempting along with my colleagues to wrest the maximum potential from within each child. Over the past roughly twenty-five years, I encountered in those trenches hundreds, even thousands, of children, the majority of whom had been diagnosed as “autistic” or a related clinical synonym before they entered the doors of my workplace.

Autism is a powerful word. It is a charged diagnosis capable of shaking the confidence of the most loving parents. It is a diagnosis which carries with it an ominous sense of an innate condition whose symptoms, it is widely thought, may perhaps be treated and improved, but for which dramatic change in a child’s essence should not be anticipated. It is a diagnosis whose impact is growing exponentially as the number of children being diagnosed as autistic continues to proliferate. And the research race is on to determine genetic markers for autism, as well as brain functioning and brain structural differences between typical and autistic populations. One encounters new information about autism, its inferred causes and its treatment, almost daily in the press. Yet not all that can be said about autism has been written. There is more that needs to be said from a different perspective, and hence the stories of the children in this book.

My clinical experience over the past generation, along with that of my colleagues, challenges many of the accepted “givens” about autism so prevalent in the field. The reader will encounter strong undercurrents within the case studies in this book, namely, my concerns that autism is being widely misdiagnosed and over-diagnosed, and that the preconception of autism as an incurable trait is harmful to the prognosis of many children so misdiagnosed (and even to those who have been correctly diagnosed).

Effective, proactive, play-based and creative ways of therapeutically working with children who are thought to be autistic do exist. This book does not claim to have discovered the “only way” to reach and meaningfully help autistic children. However, if the responses by many visiting professionals to our lectures over the years offer any gauge, in our work we do appear to have stumbled upon, no, forged a qualitatively different way of viewing and assessing autism. This way of viewing autism is not simply refreshing. It has proven essential and even life-saving in its capacity to detect strengths in the child which have been obscured rather than clarified by the current hyper-elastic criteria of the autism diagnosis. A qualitative, functionally descriptive way of playfully entering into the labyrinth of a child’s symptoms with the aim of discovering developmental strengths has proven incredibly useful in revealing the true children behind the autistic symptoms.

The reader may already have noticed that I have avoided using the term “autistic spectrum,” assumed today to hold clinical relevance. Another under current within this volume: with the onset of the term “autistic spectrum,” I worry that practitioners have seriously compromised the ability to diagnose differentially and to comprehend the individual weaknesses—and strengths—of young children who present with complex social communication difficulties.

Between 1992 and 2017, I had the privilege of working with special children at a special place alongside its special staff. This book relates the stories of some of the children with whom I worked. In 1992 I had just completed a doctorate in counseling psychology, with a subspecialty in play therapy, under the mentorship of John Allan at the University of British Columbia. Thirty days after my doctoral defense, I was boarding a plane for Israel, with a postdoctoral fellowship in hand, planning to carry out a research project in autism at the Feuerstein Institute, headed by world renowned psychologist Professor Reuven Feuerstein. I already possessed a career-long interest in the subject of autism, stretching back nearly fifteen years before that fateful flight. In various early career positions in the fields of education and psychology I had often worked with children diagnosed as autistic. That interest was about to intensify.

A word about the special place alluded to above. Known familiarly as “the Institute,” the Feuerstein Institute was founded by Sorbonne-educated psychologist Reuven Feuerstein and actively guided and headed by him until his death in 2014, a few months before his ninety-third birthday. The afternoon he died he told one of his staff that he wanted to discuss his concerns about a certain young adult with special needs in a few hours' time, but that he was tired and needed first to rest. He never woke up from that nap. Not surprisingly to those of us who had the privilege of working alongside him, struggling to keep up with his grueling, devoted and inspired pace, Reuven died with his boots on.

The Professor, or just simply Reuven, as he was affectionately known by staff, families, children and by leading specialists worldwide in the fields of education, psychology, child development, neurology and others, was a larger than life personality. He was brilliant, with a mastery not only of many languages but also more pertinently with a deep understanding of such topics as genetic syndromes, pediatric neurology, psychiatry, autism, brain plasticity—long before the term was coined—and more.

He was courageous. The fields of education and psychology are heavy with accepted truisms, which for the Professor were neither automatically accepted nor necessarily true. There were no sacred cows for the Professor. A developmental diagnosis like autism, in his estimation, might possibly serve as a weak hypothesis for the condition of a child, but it more often than not clouded our insight, masking the complex roots of a child’s problem while at the same time obscuring the latent energy and positive abilities within the child that could help symptoms considered intransigent (or innate) to fade.

Modifiability, the inherent capacity of the human being to change, was the watchword of the many cognitive enhancement and learning potential materials he developed throughout his lifetime. Those materials, chief among them the Learning Potential Assessment Device (LPAD), a qualitative, interactive method of determining children’s and adults’ potential to think and grow rather than quantifying their cognitive performance, and the cognitive development booklets known as Feuerstein’s Instrumental Enrichment (FIE) are used worldwide in dozens of countries. Their effectiveness has been documented by scores of research studies. When the concept of the plasticity of the brain entered mainstream medicine and psychology in recent years, the Professor chuckled with delight. Without the benefit of superlative brain imaging technology, he had intuited the capacity of brain cells for growth and transformation two generations earlier.

With an alternative approach to psychology which focuses on latent cognitive potential and developmental growth rather than on pathology, with materials that are effective in ferreting out hidden strengths within children and adults whose latent abilities had been ill-served by conventional intelligence and developmental evaluations, and with a deep and inspired human being at its helm, the Institute was and is a very special place. It continues to draw from all over the world families of special needs children and adults who seek its assessment and therapeutic services. Children and adults with learning problems, physical disabilities, autism, brain injuries, genetic syndromes and complex inexplicable conditions continue to crowd the halls, waiting for assessment or therapeutic interventions rooted in his visionary approach. His clinical insight, his deep humanity and his brilliance drew not only struggling and impaired populations, so many of whom were significantly helped by him and his staff. His work also attracted many therapists, educators and other specialists, like myself, hungry for a vision of psychology and education which stressed potential over pathology, and which provided a conceptual framework and tools for transforming what initially appears hopeless to hopeful.

Miracles, as they say, take longer. They did, but we all worked very hard and so we were privileged to see many: children who had been considered retarded learning to read and then integrate into regular schools, learning disabled children for whom the word “disabled” proved to be a misnomer, brain-injured children and adults whose progress stunned medical experts, and children who had been diagnosed elsewhere as autistic who improved beyond expectation. And when the miraculous was not achieved, in many cases significant and impressive progress was.

Before boarding that plane to Israel many years ago, friends had asked me what I anticipated doing at the Feuerstein Institute. I replied that I expected to have a little office from which I would carry out postdoctoral research comparing active, assertive play interventions with autistic children with conditions of accepting, empathic nondirective play therapy. I was wrong. When I arrived, there were not even enough offices in that former setting for staff members to assess and treat children. An office was out of the question. Nor was there adequate time to devote to careful research.

Soon there were competing demands on the time I had anticipated doing research. Professor Feuerstein immediately assigned me to assessing and treating children, in particular children who were considered autistic. Renowned for its pioneering work with Down syndrome children, the Feuerstein Institute was eager to deepen and broaden its involvement in the field of autism. So was I.

My research project was carried out, though not under the most rigorous standards. Having just completed a doctorate specializing in nondirective play therapy with typical children, I was surprised to find that more proactive, energetic play approaches elicited better relationship and communication responses from the autistic children in the study than an approach of quiet empathic acceptance. It was a lesson that would be relearned many hundreds of times in the years to come, with the many autistic children whom I assessed and treated.

At first I felt very much adrift at the Institute, out of my element, having just completed four years delving deeply into the world of affect, the inner emotional life of the child, and learning the wonderful treatment modality of play therapy. The Institute spoke the language of cognitive development. My heart was with the language of affect. It was the world of play which would bridge the two realms.

The Professor maintained active, warm relationships with many leading experts in the fields of education, psychology, neurology, child development and more. One of these individuals was Dr. Serena Wieder, co-developer with the late Dr. Stanley Greenspan of Floortime, a play-based, developmentally grounded intervention for autistic children, widely used and enjoying much success. In the late 1990s and for several years following, Professor Feuerstein ensured that the nucleus of his staff who worked with autistic children were able to attend the remarkable international conferences on the topic of autism organized by Wieder and Greenspan. These conferences showcased medical research, findings about the effectiveness of their developmental (D), individually attuned (I), relationship based (R) model DIR, state of the art information on topics related to nutrition, allergies, auditory processing and much more as related to autism, all presented by experts in their fields. Following one of these conferences, I flew again to the East Coast to take an initial course in the essentials of DIRFloortime practice. This was followed by several tutorial group workshops with Serena Wieder, which she conducted when in Israel.

With a strong background in play therapy, I was well aware of the critical importance of play in the development of the young child. One does not need to have training in play therapy in order to appreciate and apply the principles discussed in this book. One does require, however, a deep appreciation and understanding of how powerful a tool play can be in reaching any child.

If we carefully observe children at play, we will find that, in their play, children are telling us so much about themselves in a myriad of developmental realms: their understanding of the world and of social relationships, their capacity for relating, their capacity for imagination and pretense, their capacity for language and communication, their capacity for the expression of emotions and for emotional reciprocity, their capacity for focus and attention, their levels of fine motricity (finger and hand dexterity) and gross motricity (larger bodily movements), their levels of understanding and cognition (thinking), their personality development and sense of self. Play truly functions as a mirror of the child’s capacities. If we look deeply into that mirror, we find that so much is reflected about the developmental functioning of the child. The information we glean will not necessarily lead us to statistical information which can be normed, but it will provide us with a rich qualitative description of the difficulties—and capacities—of each child.

Play offers yet more. It is a two-way street. From one perspective, play reflects and expresses the child’s challenges and abilities. From another, play offers an active, energetic conduit to influence and improve the child’s abilities. To a remarkable degree, the developers of DIRFloortime utilized the power of active, energetic and even caringly intrusive play to pierce the autistic shell and to woo the autistic child into relationship and reciprocal communication.

I had been schooled to use play in play therapy as an empathically receptive tool, providing the emotional greenhouse conditions for troubled children to begin to trust, find their strengths and shed their symptoms. My general postdoctoral research findings, though, had shown that proactively asserting oneself into the world of the autistic child serves to elicit more positive responses than by empathically accepting the child (as in play therapy practice) and assuming that he or she will find the direction out of the autism labyrinth. To some readers this may be obvious. For me, it was part of a steep learning curve. Beyond these postdoctoral research findings, after having gained some competence in the playfully assertive strategies of DIRFloortime, my growing experience with autistic children at the Institute was confirming to me that proactive play strategies can work wonders in treating children considered autistic. Further, these same play strategies served me as a basis for carrying out qualitative (descriptive), interactive assessments of the functioning of children thought to be autistic.

Dynamic (interactive) assessments are the lifeblood of the work at the Institute. In a dynamic assessment, the assessor (or mediator in Feuerstein parlance) seeks change, evidence of modifiability, in cognitive and developmental abilities during the intentionally interactive assessment process itself. The dynamic assessor does not seek to quantify and then norm statistical evidence of a child’s performance. Rather, in dynamic assessment the assessor seeks descriptive understanding of the child’s process functioning and, above all, clues as to what aspects of the mediator’s intentional and active intervention prompted the change in the child’s profile in real time during the assessment.

Experience and comfort with play, play-based DIRFloortime strategies, and the need for qualitative assessment information in order to tease out the true potential of the child behind the autistic symptoms—it all began to come together. This book relates the impact of the synergistic use of play strategies derived from DIRFloortime during dynamic assessments (and treatment) within the Feuerstein clinical paradigm, which is dedicated to modifiability and the realization of the maximum potential of each child.

At its heart, this book is a casebook telling of the challenges, while charting the progress, of children who arrived at the Institute having been diagnosed elsewhere as autistic. The story of each child has much to teach: about the limits of a diagnostic term, about the dangers of misdiagnosis and overused diagnostic terminology, about how preconceptions about the intransigence of certain symptoms too often inhibit therapeutic efforts, about the developmental and therapeutic benefits of seeking strengths within the most challenging profile, about how play strategies can trump symptom lists in enlightening us about a child’s potential, and about the developmental resilience of many children and the courage of their parents.

Following the first section of eight case stories, the second section presents the theoretical groundings of work that combined the essentials of the Feuerstein emphasis on modifiability with the developmental, play-based elements of DIRFloortime. After introducing these two discrete yet compatible models, there are chapters on islets of normalcy, the first an introduction to the concept, the second a guide for identifying them. The term “islets of normalcy” is pivotal in distinguishing the Feuerstein paradigm, which focuses on eliciting the strengths of the child with autistic-like (autistiform) symptoms rather than on documenting pathology. Following are a close reading of the most recent castings of the formal criteria for autism, and a call to strengthen the prevalence of the use of the term autistiform. Liberally illustrated with case examples, the theoretical section concludes with a discussion of how the needed paradigm shift from a quantitatively symptom-focused to a qualitatively strength-focused perspective has the potential to strengthen assessment of and interventions for children who present with autistiform symptoms.

This book is not a compendium of the latest fascinating neurological, biochemical or genetic research as it pertains to autism. Nor does it survey the most prominent treatment techniques. I have written this book, based on years of clinical experience, in the spirit of sharing: thoughts about the field of autism, reflections about the way autism is currently diagnosed, concerns about the misuse and over-diagnosis of the term autism, encouraging examples of children thought to be autistic whose lives were changed when we uncovered the child behind the symptoms; insights into how what might even be called an iconoclastic vision of autism can lead to dramatic progress beyond initial expectations.

A word about the term “autistic” itself as used in this introductory chapter and following is in order. For the most part in the field, the diagnosis of autism is used as a sacrosanct truism—a definable entity, the symptoms of which, like a disease, can be quantified readily and clearly identified. As the children in this book and their stories hopefully exemplify, such is not at all the case. I have found that the term “autism,” as it appears commonly in the field, in actuality is being used to describe children who suffer from a vast range of communication difficulties, from extreme shyness to psychotic conditions and just about everything in between. It is not at all clear to me how research studies which purport to use autistic children as subjects can be certain that they have in fact studied autistic children, with the current diagnostic criteria of autism so elastic and with the use of the term so liberal.

So when I use “autistic” or “autism” in this introduction and throughout the book, I am using it as a reference point to indicate children who are/were thought to be autistic—although they might not be genuinely autistic at all, given the vast range of developmental challenges that the term “spectrum” allows. In the case vignettes I refer often to children who were “thought to be autistic,” “diagnosed as autistic,” “considered autistic” in order to imply a healthy doubt as to whether their original diagnoses were accurate. I have also used these kinds of descriptive phrases within the case stories in order to distinguish the formal diagnosis and the attendant presumptions that accompanied each child’s referral information, from the more qualitative, functional and often deeper understanding of the child’s difficulties and strengths which were elicited from our play-based dynamic, interactive assessments.

Increasingly in the writing of these case stories, I came to use the term “autistiform,” not to define the child but to describe the quality of the symptoms. This term is not a diagnosis. It is, in fact, an excellent descriptor in its non-specificity, and it means essentially “kind of looks autistic” or “sort of reminds me of autism.” The reader may be shocked at this assumption: how can such a non-specific term enlighten the practitioner or aid the parent?

As I will argue in the chapter devoted to a close reading of the formal diagnostic criteria for autism, I observed that the current formal criteria for autistic spectrum do not offer the practitioner a clear, differential diagnosis, one which distinguishes between genuine autism as per Leo Kanner’s (1943) original criteria—emotional cutoffness and an obsessive insistence on sameness engendering perseverative behaviors—and myriad potential false positives.

The diagnosis of “autistic spectrum,” like the now obsolete diagnosis of Pervasive Developmental Disorder (PDD) in common coinage before the term “spectrum,” is non-specific. A close reading of the current diagnostic criteria for “autistic spectrum,” greatly expanded from Kanner’s original criteria and with a corresponding loss of clinical specificity, reveals that the term “spectrum” barely provides the practitioner with enough information to conclude that the child’s functioning “sort of looks like autism.” In a later chapter, I respond to the implicit question: so why replace one general term, “spectrum,” with another, “autistiform”?

The parents of most of the children presented in this book arrived at the Institute seeking an alternative type of assessment which they hoped would clarify the accuracy of the formal diagnosis they had received elsewhere. With nearly every case story in this book I have attempted to demonstrate how the children’s progress ultimately revealed that the formal autism diagnostic criteria had led essentially to a misdiagnosis which had masked or even overlooked the underlying difficulties—and the positive potential—within each child. It is against this theoretical backdrop that each child’s progress, sometimes remarkable, sometimes adequate, sometimes minimal yet still significant, is presented.

The story of each child in this book exemplifies in a different way and from a slightly different perspective how the layers of assumptions associated with a formal autism diagnosis were peeled away to reveal the child behind the autistiform symptoms. Jack’s story tells of a delightful little boy, misdiagnosed in my estimation, and the struggle of his parents to overcome the burden of doubt a formal diagnosis engenders. The story of baby Sasha challenges the presumed need for early diagnosis and argues instead that early understanding of developmental needs and early intervention rather than early classifying serve the practitioner and the child more effectively. Annie visited the Institute only a few times, yet her anxious parents trusted that our formulation of Annie’s considerable developmental problems—and her latent potential—would somehow lead to her much improved functioning. Davie’s parents too wrestled with doubts, as they struggled to believe in his emerging potential. The story of Joe relays the challenges and the developmental changes that occurred when working with a middle-teenaged youth with entrenched symptoms and behavior patterns. Mikey’s depressed mother had stopped talking to her child. Max had been misdiagnosed due to misinterpretations of his nonspeaking behavior. Josh is now a talented, normally functioning, productive adult, but as a preschooler he presented with what was far from a positive prognosis.

At the Institute, my colleagues and I assessed and followed the progress of likely thousands more children. The reader will note in these case stories that there was and is no set timeline for staff involvement with families who come to the Institute. During my tenure, there were families who came once or twice for an initial assessment or for a second professional opinion regarding their child’s challenges and abilities. Often these few initial play-based assessments, which also employed DIR strategies that proved so compatible with the Feuerstein philosophy of modifiability, were nevertheless fruitful, in the sense that within a session or two there were positive, even if small, changes observed or elicited in the child’s presentation. As we sometimes learned from the parents who phoned to update us years later, these small changes, along with the specific advice and recommendations we provided the parents, often had prompted a positive, creative change in the parents’ approach and the treatment decisions they made for their child. The children whose stories are told here were seen at the Institute for varying lengths of time, ranging from only one or two assessment sessions, to intermittent follow-ups, to more frequent contact over a period of years.

In compiling these stories, I endeavored to select children for whom I had access to my personal notes, although in some cases I relied on my memories of dramatic, pivotal moments in the assessment or treatment of the children. In the instances for which I relied on memory, certain details, such as the exact play material or play-based learning activity I used to engage a given child, may not be accurate. However, the overall trajectories of developmental change, the direction and degree of progress, as described for each child, are accurate. Clearly, all names and identifying background details have been altered in order to protect the confidentiality of the children and their parents.

The case stories I selected pivot around my experience with the children in my office during assessment, treatment and follow-up sessions. I have focused on what transpired before my eyes within the confines of my office because that is what I could report accurately regarding the initial assessment of the children, my comprehension of their underlying difficulties, and the sometimes painful yet hopeful process their parents underwent during our consultations. Most of the children whose stories comprise this casebook were not able to enjoy the benefits of the multidisciplinary team of the Institute’s intensive treatment program, which was created years later. However, the voices and the talents of my colleagues, from whom I learned so much, resonate through these pages as well. Inspired by the Professor, the Institute’s clinical staff aspired to make a significant difference in the lives of any and all special needs children. When families did not return, there was always a sense of sadness among the staff and an air of self-criticism: What had I missed? What more could have been done? My colleagues and I hoped to make a difference in the developmental trajectory even of a child with complex difficulties who visited us short term.

How I would have loved to compile a book comprised solely of astounding successes, one in which every child who arrived at the Institute previously diagnosed as autistic had begun, with our influence, to speak fluently, to learn at a normative level and to play happily with friends. That, of course, was not the reality of our work. However, it can safely and honestly be stated that, inspired and mentored by the Professor, my colleagues and I made a huge difference in the lives of hundreds of children originally thought to be autistic. We were able to meaningfully change children’s prognoses and to disprove many clinical assumptions embedded in the reports of those who had evaluated the children elsewhere. It would not be inaccurate to say that as a team we were able to save many lives.

It is my hope that the case stories in this book will help strengthen parents struggling to trust their own intuition and belief in their child’s capacities, regardless of the technical accuracy of an autism diagnosis. I hope that cumulatively these stories will help broaden and deepen the perspective of students of psychology and education so that they will enter into practice with a flexible and creative outlook regarding the autism diagnosis, rather than a rigid, constraining, deterministic or even fatalistic outlook. I also hope that in some way these stories will encourage instructors in the fields of psychology, counseling and education to expose their students to alternative ways of arriving at creative and reflective practice with children presumed to be autistic.

While, yes, there are children who are genuinely autistic, as per a stringent interpretation of Kanner’s original succinct formulation, and it is likely that their numbers are indeed increasing, nevertheless, an alternative model for the assessment and treatment of autism, as it can hopefully be taught and practiced, might just help stem the tide of falsely positive and misleading autism spectrum diagnoses flooding the field today. For those children for whom a misdiagnosis of autism has masked or obscured other developmental difficulties, and perhaps masked latent potential as well, I hope that this case based description of an exciting, creative and satisfying way of working clinically will help reveal to many parents and practitioners the children behind the symptoms.

Notes

1 Reuven Feuerstein, Yaakov Rand, and Mildred B. Hoffman, Dynamic Assessment of Retarded Performers: The Learning Potential Assessment Device, Theory, Instruments and Technique (Baltimore, MD: University Park Press, 1979). The word “potential” was later changed to “propensity.”

2 Reuven Feuerstein et al., Instrumental Enrichment (Baltimore, MD: University Park Press, 1980).

3 Dorothy R. Howie, Thinking about the Teaching of Thinking: The Feuerstein Approach (London: Routledge, 2003).

4 Alex Kozulin et al., “Cognitive Modifiability of Children with Developmental Disabilities: A Multicenter Study Using Feuerstein’s Instrumental Enrichment-Basic Program,” Research in Developmental Disabilities 31 (March–April 2010): 551–59.

5 Daniel D. Kurylo et al., “Remediation of Perceptual Organization in Schizophrenia,” Cognitive Neuropsychiatry 23, no. 5 (2018): 267–83.

6 Stanley I. Greenspan and Serena Wieder, The Child with Special Needs (Reading, MA: Addison-Wesley, 1998).

7 Stanley I. Greenspan and Serena Wieder, Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think (Boston, MA: DaCapo Press, 2009).

8 DIR is a registered trademark of the ICDL, the Interdisciplinary Council on Developmental and Learning Disorders.

9 Leo Kanner, “Autistic Disturbances of Affective Contact,” Nervous Child 2 (1943): 217–50. Throughout this book, whenever the term “genuine autism” appears, I am intending a stringent interpretation of Kanner’s two primary criteria, emotional cutoffness and an obsessive insistence on sameness, along with his secondary criterion of impairments in communication.

References

Feuerstein, Reuven, Yaakov Rand, and Mildred B. Hoffman. Dynamic Assessment of Retarded Performers: The Learning Potential Assessment Device. Baltimore: University Park Press, 1979.

Feuerstein, Reuven, Yaakov Rand, Mildred B. Hoffman, and Ronald Miller. Instrumental Enrichment. Baltimore, MD: University Park Press, 1980.

Greenspan, Stanley I. and Serena Wieder. The Child with Special Needs. Reading, MA: Addison-Wesley, 1998.

Greenspan, Stanley I. and Serena Wieder. Engaging Autism: Using the Floortime Approach to Help Children Relate, Communicate and Think. Boston, MA: DaCapo Press, 2009.

Howie, Dorothy R. Thinking about the Teaching of Thinking: The Feuerstein Approach. London: Routledge, 2003.

Kanner, Leo. “Autistic Disturbances of Affective Contact.” Nervous Child 2 (1943): 217–50.

Kozulin, Alex, Jo LeBeer, Antonia Madella-Noja, Francisco Gonzalez, Naama Rosenthal, Ingrid Jeffrey, and Meni Koslowsky. “Cognitive Modifiability of Children with Developmental Disabilities: A Multicenter Study Using Feuerstein’s Instrumental Enrichment-Basic Program.” Research in Developmental Disabilities 31, no. 2 (2010): 551–59.

Kurylo, Daniel D., Richard Waxman, Steven M. Silverstein, Batya Weinstein, Jacob Kader, and Ioannis Michalopoulous. “Remediation of Perceptual Organization in Schizophrenia.” Cognitive Neuropsychiatry 23, no. 5 (2018): 267–83.