Book Review

Autism: A Neurological Disorder of Early Brain Development

N Engl J Med 2007; 356:1690-1691April 19, 2007

Article

Autism: A Neurological Disorder of Early Brain Development
(International Review of Child Neurology Series.) Edited by Roberto Tuchman and Isabelle Rapin. 354 pp. London, Mac Keith Press, 2006. $115. ISBN: 978-1-898683-49-0

There is a bit of irony that not since the time of Bruno Bettelheim's The Empty Fortress: Infantile Autism and the Birth of the Self (New York: Free Press, 1967) has autism enjoyed so much interest. There has been an explosion of research into the causes of and treatments for autism (both rational and not so rational) and an increasing number of government initiatives to support research, training, and education in the area (again, both rational and not so rational). Irrespective of where one stands on the “hot” political issues associated with autism, there is little doubt that there has been a dramatic change in the general view of its epidemiology: prevalence has grown from approximately 0.1% to 0.8% of the population. With this rise in prevalence (curiously, with no substantial evidence of a rise in incidence), there have been increasing demands for clinical and educational services. To meet these demands, both the clinical and scientific communities that focus on autism have taken a strong multidisciplinary and multimodal approach to research and practice. This leads to another irony — that pediatric neurologists have seized this moment to publish Autism: A Neurological Disorder of Early Brain Development, a book edited and written almost entirely by pediatric neurologists and for pediatric neurologists about a disorder that is anything but solely in the domain of pediatric neurology.

From the time of Leo Kanner's groundbreaking 1943 clinical paper on autism, it has been largely assumed that autism is a neurobiologic disorder. Admittedly, there was a period of time when psychological and psychoanalytic constructs enjoyed popularity, but during most of the modern history of autism, there has been a rigorous search for the neural mechanisms underlying the disorder. And as Martha Denckla points out in her preface to the book, “The glaring gap in our knowledge about the social–emotional brain is like a `black hole' in the book and accurately reflects the field of research it represents.” She goes on to explain, “It is not the fault of Roberto Tuchman that his important chapter called `The Social Deficit in Autism' (Chapter 3) falls so short of its title.” Although the book has some other weaknesses, it is hardly bereft of knowledge.

This generally well-referenced book contains 19 chapters of widely varying length and quality. The strongest and longest chapter, “Atypical Sensory/Perceptual Responsiveness,” was written by Isabelle Rapin, an acknowledged expert on this curious problem that is a critical element of autism and similar developmental disorders. She systematically approaches various measurement and neurologic issues, leaving the reader with a solid, well-referenced foundation. And despite Denckla's warning, I found Tuchman's chapter on social deficit to be thoughtful and interesting.

Areas in which one would expect substantial expertise in pediatric neurology, however, are relatively weak. For example, it is unclear why there are two chapters addressing the topic of epilepsy and autism; there are, not surprisingly, redundancies in the information provided, but there are also important gaps. There is no discussion of childhood epilepsy as a genetic disorder that may be linked to the genesis of autism and virtually no mention of the complex questions related to the treatment of epilepsy in association with autism. Similarly, there are two seemingly disconnected chapters on sleep, and the discussion in both is superficial and lacking in clear treatment guidelines for this critical clinical problem.

Based on its title, this book would seem to have great potential. Unfortunately, aside from a few select chapters and excellent references, it is superficial and fails to capture the richness of the work in the field. Although it may serve as a useful reference from time to time, other books have been published that are better suited for inclusion in a library.

Bennett L. Leventhal, M.D.
University of Illinois College of Medicine, Chicago, IL 60608
bll@uic.edu