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Biographies of Disease: Autism

Choueiri, Roula MD

Journal of Developmental & Behavioral Pediatrics: October 2010 - Volume 31 - Issue 8 - p 648
doi: 10.1097/DBP.0b013e3181f08e86
Book Review

Neurodevelopmental Pediatrics; Floating Hospital for Children; Boston, MA

by Lisa D. Benaron, Westport, CT, Greenwood Publishing Group, Inc., 251 pp, Hardcover, $45.00

If you are looking for a book that presents a synthesis of what is known so far about autism spectrum disorders (ASDs) in an objective way, presenting what is known and scientifically supported as well as what is proposed from controversial theories, you have found it! Whether it is the review of the evolution of our understanding of ASDs or the screening of ASD, diagnostic evaluations, and treatments, it is nicely written and well updated. Different sections were reviewed by experts in the field, including Frances Page Glascoe, Nancy Wiseman, Ami Klin, Judy Van de Water, Deborah Fein, Amy Wetherby, and others.

This text starts with a solid historical review of the evolution of the concept of ASDs, discusses currently available tools for the screening for ASD, and presents current research for screening in children younger than 18 months. I found the diagnostic evaluation of ASD well written, and it dissects nicely and in a comprehensive way the DSM-IV criteria, which are helpful to any clinician in the field asked to evaluate a child for ASD.

The book then goes into a discussion of what we know about the causes so far, dividing them into either a basic science category (what is supported by basic science studies such as teratogenic factors, genetic causes, epigenetic causes, and functional magnetic resonance imaging studies) or the controversial theories category without this evidence base. The discussion stays objective, presenting the history behind the development of the DAN (Defeat Autism Now) movement and its belief that changes seen in the brain of children with ASD are not irreversible. Controversial etiological theories such as the role of the MMR vaccine, mitochondrial disorder association, gut-brain theory, mercury, and immune system in the cause of ASDs are described.

Treatment is also discussed and reviewed as conventional and educational interventions as well as biomedical interventions. The conventional part is developed to include a good historical background about the different treatment modalities, including ABA, floortime, TEACCH, SCERTS, PRT, social stories, and focused interventions; this part covers medications briefly. The biomedical part presents the theories behind treatments such as the gluten- and casein-free diet, chelation, and hyperbaric oxygen use. Outcome is reviewed through the presentation of older longitudinal studies and discussion of predictors of outcome in older children and what the current research shows in younger children. The book ends with a summary of the timeline in the history of autism and scientific advances as well as a glossary.

I thought that this is really a nice overview and synthesis of what we currently know. Of course, since its publication, we already have a different prevalence of 1:100 for ASD, and The Lancet refuted the article of Dr. Wakefield that started the controversy about vaccines, gut, and autism. Nevertheless, the book does a wonderful job in presenting current data, theories, results, and research in a simple and clear way. This book can be extremely helpful for pediatricians, fellows, clinicians working with children with ASD, DBP, and families.

Roula Choueiri, MD

Neurodevelopmental Pediatrics

Floating Hospital for Children

Boston, MA

© 2010 Lippincott Williams & Wilkins, Inc.