by Martin Bax, Christopher Gillberg, London, Mac Keith Press, 2010, 176 pp, Paperback, $95.00
“We think in generalities but live in details.” Comorbidities in Developmental Disorders opens with this quote by Alfred Whitehead, which certainly rings true for those who care for children with developmental disabilities. The majority of neurodevelopmental disorders encountered in pediatric practice have a high incidence of comorbid conditions and rarely seem to present in isolation. Thus, this book explores several common neurodevelopmental conditions and their comorbidities. The boundaries between these complex disorders can at times be blurry, and often multiple conditions are interrelated and co-occurring. A good clinical assessment must not solely focus on recognizing the core symptoms of a disorder but should evaluate for associated problems as well. Management may be affected in treating co-occurring conditions because of challenges in diagnosis, increased complexity of pharmacologic treatment, and implications for long-term outcomes.
The editors did not seek to provide a systematic review of common comorbidities in developmental disorders; rather, they present a collection of essays on a range of relevant topics written by experts in the field. At the outset, the editors grapple with the complex meaning of the word “comorbidity,” and its implication in the context of developmental disorders. They acknowledge that the various authors who contributed to the book have varied perspectives when using the term. This theme repeatedly emerges throughout the chapters, but the overarching message is that regardless of terminology used, as clinicians our task is to identify the problems that negatively impact quality of life and to find solutions for them.
Most chapters of the book focus on a specific developmental disorder and discuss the commonly associated comorbidities or how these disorders may manifest in the context of other conditions. Featured topics include autism, attention-deficit hyperactivity disorder (ADHD), intellectual disability, language disorders, and Tourette syndrome. Two chapters provide an in-depth review of the possible genetic and neurobiological underpinnings of specific neurodevelopmental disorders and their comorbidities, specifically, fragile X syndrome and various channelopathies that give rise to movement disorders. Yet another chapter examines developmental comorbidities from a life course perspective. The chapters are brief yet enlightening. Each chapter includes an extensive reference section, which allows professionals to pursue more information on a particular topic as needed.
The chapter on intellectual disabilities provides a thoughtful discussion of the increased rates of behavioral disorders in these individuals, including a brief review of behavioral phenotypes associated with specific genetic disorders, the characteristic developmental trajectories of certain conditions (e.g., Rett syndrome and Trisomy 21), and the importance of considering possible contributing factors (e.g., bereavement and abuse) before attributing new behavioral symptoms solely to the presence of intellectual disability. In the chapter on ADHD, the author discusses reasons that children with ADHD may meet criteria for another diagnosis, such as overlapping symptoms among some mental health diagnoses, common risk factors for multiple disorders, and changes in development over time. This chapter is particularly valuable to clinicians as frequently encountered diagnostic dilemmas are explored such as assessing inattention in the context of learning difficulties and the approach to management when a tic disorder is present.
This rich book is recommended for professionals working with children with neurodevelopmental disabilities. It may also be an interesting read for generalists who are the front lines in caring for children with developmental disorders. In a concise manner, the authors present evidence-based discussions of the complexities inherent to diagnosing and managing these conditions. The authors probe into the overlapping features and also distinctive attributes of the disorders, allowing the reader to fine-tune their diagnostic acumen. They also acknowledge the limitations in our current understanding of the underlying mechanisms by which these conditions develop and co-occur and the resultant shortcomings of our current diagnostic system. Comorbidities in Developmental Disorders encourages its readers to reflect on how neurodevelopmental diagnoses are made, how comorbid conditions influence treatment, the possible underlying pathologies that may explain a range of clinical features, and most importantly, what all of this means to our patients and their families.
Oana de Vinck-Baroody, DO
Nili E. Major, MD
Yale Department of Pediatrics
Subsection of Developmental-Behavioral Pediatrics