8/12/2019 Nej Mb Krev 57295

http://slidepdf.com/reader/full/nej-mb-krev-57295 1/1

The new england journal of medicine

n engl j med 356;16 www.nejm.org april 19, 20071690

Understanding Autism:

From Basic Neuroscience

to Treatment

Edited by Steven O. Moldin and John L.R. Rubenstein.526 pp., illustrated. Boca Raton, FL, CRC Press, 2006.

$159.95. ISBN 978-0-8493-2732-2.

Autism is an elusive developmental

disorder that has been the focus of increas-ingly intense scrutiny over the past two decades. As

with most aspects of research, the more we under-stand this enigma, the more we realize we have yetto learn. This collection of reviews, written by a

who’s who in autism research, eloquently bringsthe reader up to date on the progress in all perti-nent aspects of the research and presents an effec-tive framework for future investigations.

Even for those who work daily in autism re-search, specialization makes it difficult to keepabreast of the progress in all areas of the field.This book provides outstanding updates in diagno-sis, epidemiology, genetics and genomics, neuro-anatomy, neurophysiology, neuropsychology, andthe neural systems underlying the inherent behav-ioral aspects of autism. For those unfamiliar withautism, the book contains concise reviews of themyriad facets of the disorder; these reviews arehighly appropriate teaching tools for the nextgeneration of clinicians and researchers. Parents,however, may find the book too technical; it isprobably not suitable for the average lay reader.

Several chapters merit specific mention. Chap-ter 9, “Language in Autism,” is a coherent accountof the linguistic components that underlie the ver-bal and nonverbal communication deficits founduniversally in people with autism. This chapteralso includes clear descriptions of the integrativetheories of language, including the theory of mindand the procedural memory system. Chapter 17,“Neuropsychology and Neurophysiology of AutismSpectrum Disorders,” is a succinct review of mod-els of cognitive dysfunction in autism, including

complex information processing, local–global pro-cessing, and executive function. Chapter 19, “Be-havioral, Educational, and Developmental Treat-ments for Autism,” concisely covers appropriatelanguage and social interventions for younger as

well as older children with autism, including re- views of comprehensive treatment approaches forpreschoolers. Perhaps the most powerful chapteris the final one, “The Costs of Autism,” an articu-

late outline of the exorbitant direct and indirectcosts of autism to the individual, to families, andto society in the 21st century.

This book is somewhat difficult to read fromcover to cover because it lacks a common threadto connect the chapters. Although described in thepreface as comprising six distinct sections (diag-nosis and epidemiology; genetics and genomics;behavior and underlying neural systems; clinicalfindings in neuropsychology, neuroanatomy, neu-roimaging, and neurophysiology; treatment; andeconomics), the book contains no section intro-ductions and no text to link the topics betweenand across sections and chapters. The section onneural systems and behavior (chapters 7 through13) is especially disjointed, with the chapter top-ics jumping from fear and anxiety to cerebellarnetworks to language, the prefrontal cortex, theamygdala, and the thalamus. These drawbacksnotwithstanding, this book is a seminal work thatmakes a highly important contribution to the fieldof autism research.Pauline A. Filipek, M.D.University of California, Irvine, School of MedicineIrvine, CA 92697

Autism: A Neurological

Disorder of Early Brain

Development

(International Review of Child Neurology Series.) Edited byRoberto 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 For-

tress: Infantile Autism and the Birth of the Self (NewYork: Free Press, 1967) has autism enjoyed so muchinterest. There has been an explosion of researchinto the causes of and treatments for autism (bothrational and not so rational) and an increasing

number of government initiatives to support re-search, training, and education in the area (again,both rational and not so rational). Irrespective of

where one stands on the “hot” political issues as-sociated with autism, there is little doubt that therehas been a dramatic change in the general view ofits epidemiology: prevalence has grown from ap-proximately 0.1% to 0.8% of the population. Withthis rise in prevalence (curiously, with no substan-

The New England Journal of MedicineDownloaded from nejm.org by syahrul rezza on October 8, 2011. For personal use only. No other uses without permission.

Copyright © 2007 Massachusetts Medical Society. All rights reserved.