Book Review

Textbook of Pediatric Neuropsychiatry

N Engl J Med 1999; 340:820March 11, 1999

Article

Textbook of Pediatric Neuropsychiatry
Edited by C. Edward Coffey and Roger A. Brumback. 1566 pp., illustrated. Washington, D.C., American Psychiatric Press, 1998. $150. ISBN: 0-88048-766-6

Alexander Pope said, “The proper study of mankind is man.” Surely, studying the development of the human brain, mind, and personality — and their disorders — is one of the great scientific tasks of the coming century. In past generations, humans studied humans by observation and contemplation, a process systematized to great advantage by psychologists. And as always in medicine, disease provides not only the practical spur, but also the indispensable key to such investigation.

The editors of the Textbook of Pediatric Neuropsychiatry define neuropsychiatry as the discipline devoted to understanding the neurobiologic basis of human behavior. This massive book demonstrates beyond question that we are ready to address the relation between neuropsychiatric illness and the neurobiology of behavioral development. It encompasses, in great detail, what we currently know about child neurology, child psychiatry, psychology, pediatrics, and neurogenetics. This knowledge is still largely descriptive; there is much more information than there are answers, more studies than conclusions. But just as the infant peers before seeing, so it is with science: we need to look, to direct attention, before we can see. This book proves that we are looking.

How different it was 25 years ago. Then, many families brought children to me with behavioral and developmental problems. They had seen neurologists, who confirmed that the children's reflexes were normal, and psychiatrists, who engaged in play therapy or family therapy — and the problems of the children and their families fell between the two approaches. This situation has since changed immensely. Pediatric neurologists now take behavior seriously, as seriously as child psychiatrists take neurobiology.

This book is a testament to how far we have come. Edited by a psychiatrist who is also a neurologist and a pediatric neurologist long interested in psychiatry, it includes authoritative discussions of current research and practice in every phase of pediatric neuropsychiatry, by recognized leaders in each area. It can be referred to confidently as an authoritative textbook presenting the current understanding of pediatric neurologic and psychiatric issues. Its breadth, depth, comprehensiveness, uniform high quality, and timeliness (the literature for 1997 is nearly fully covered) are little short of amazing, and they are a tribute to the editors.

In addition to an introductory section, there are sections on the neuropsychiatric assessment of the child, including detailed information on neuropsychological and psychoeducational evaluation and chapters on advanced techniques for imaging the brain; clinical sections on the neuropsychiatric aspects of psychiatric and neurologic disorders; and a section containing comprehensive information on all aspects of treatment. A notable feature throughout is the series of tables, appendixes, and similar compendiums of useful information on descriptive neuropsychological tests and clinical and research instruments for the assessment of speech and language and other functions.

The references are extensive. The richness and completeness of the material is remarkable; this feature in itself makes the book indispensable. Some contributions stand out: the review of recent studies of language acquisition in infants and the detailed discussion of electroconvulsive therapy for adolescents, complete with case histories. Some large problems are presented from more than one point of view, perhaps balancing an occasional idiosyncracy. Some areas are difficult by their nature; autism, for example, remains a thicket, with no clear path through. Some might wish for a fuller treatment of neurotransmitter and receptor pharmacology. But these quibbles cannot obscure the grand achievement here.

This textbook marks a new era in pediatric neuropsychiatry and probably in human neuroscience. It is legitimately a landmark. In bringing together in masterly fashion strands that have been developing here and there, it represents a major intellectual event. It clearly sets the agenda for a neurobiologic understanding of human neurologic and psychiatric development. This book will be on the “must have” list of anyone with a scholarly interest in the neurologic and neuropsychiatric development and disorders of children.

G. Robert DeLong, M.D.
Duke University Medical Center, Durham, NC 27710