A clinical guide to autistic spectrum disorders

A clinical guide to autistic spectrum disorders

european journal of paediatric neurology 16 (2012) 758 Official Journal of the European Paediatric Neurology Society Book review A clinical guide to...

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european journal of paediatric neurology 16 (2012) 758

Official Journal of the European Paediatric Neurology Society

Book review A clinical guide to autistic spectrum disorders, Patrcia Evans, Mary Ann Morris, Lippincott Williams & Wilkins (2011). Softcover, 128 pp. £46. ISBN 9781608312696. The number of people with a diagnosis of autistic spectrum disorder (ASD) has grown significantly over the past fifteen years. To some extent this is because of the change in the diagnostic criteria but also is due to increased recognition. All medical professionals need to be sensitive to the suggestive symptoms and signs so that the diagnostic process may start early. This book is especially directed towards primary care doctors who, as the first medical contact point, are in a good position to spot any problems early and initiate appropriate interventions. The authors comment that this is an often neglected group of patients but that it ‘consists often of delightfully interesting and truly unique individuals’. The content of the book is grouped into four parts. Part 1 contains a short discussion of history, definition and current views regarding the neurobiology of autism. Part 2 deals with diagnostics. It is divided according to the most common presenting problems: developmental delays, odd behaviours, regression, vegetative disturbances and psychiatric problems. Here there are also chapters about adults with ASD and some discussing some ethical issues. At the beginning of each chapter there is a case history to illustrate the topic of the chapter; this I found especially helpful as it brought to my mind similar case histories from my personal practice and facilitated comparison, learning and understanding. Each chapter contains also many practical suggestions for the primary care clinician together with flowcharts and diagnostic and therapeutical diagrams. The next part of the book is devoted to therapeutic topics. This for many might be the most helpful part. Even among professionals there is a degree of confusion about some aspects of management of the ASD patient. The authors introduce three main therapeutic principles. The first one is

that the basic treatment must take place in the everyday environment of the person. This is a task for parents, carers, teachers and therapists: to create a milieu where a plan designed for the patient can be realised. This should be complemented by various specific therapies like speech and language, occupational, social etc. Finally in the third place there are pharmacological treatments. For ASD this is palliative care and should not be used without appropriate social and emotional support. However, in conjunction with the other types of treatment it can bring on a dramatic improvement in the patient’s condition. The last chapter of this part is “Complementary and alternative medicine”. The authors stress that the ‘those therapies which to date have either inadequate or no basis in scientific or peer-reviewed research specific to ASD should be avoided’ and list a sample of various such therapies. In my view this very chapter, short and in a way marginal, shows best how important the message of the book is: In Poland, but also in many other countries, children with ASD receive therapy later than optimal and this is partly due to the fact that many clinicians are not sufficiently familiar with the manifestations of ASD. Additionally, the number of centres that offer diagnosis and treatment for these children is very limited. Many parents in desperation turn to doubtful and occasionally harmful forms of therapy, wasting time and money. The last part of the book deals with issues related to schooling, based on the USA school system. There is also an Appendix with links to websites and various other resources. Irena Dyduch Paediatric Neurology Outpatients, Bochnia, Poland E-mail address: [email protected] 1090-3798/$ e see front matter http://dx.doi.org/10.1016/j.ejpn.2012.07.005