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The biology of the autistic syndromes.
  1. MARK HUNTER, Consultant in Community Paediatrics
  1. Banbury, UK

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    The biology of the autistic syndromes. Gillberg C, Coleman M. (Pp330, hardback). Cambridge, UK: MacKeith Press, 2000. ISBN 1898683220.

    I'm never sure if it is good sign when the receipt of a new edition of a book is accompanied by the feeling that the previous edition has only just appeared. I was surprised to find that eight years have elapsed between the second and third editions of this work. The eight years have produced a major revision with a reduction in the number of chapters (most completely rewritten) and evidence of self restraint in a mere 4% increase in the number of pages.

    One addition is that of a preface devoted to a robust defence of the concept of autistic syndromes rather than that of an autistic spectrum. Readers will have to judge for themselves but this reviewer was not convinced by the arguments presented. The presence of a table in chapter 2 devoted to the autistic spectrum and the title of chapter 8 (The epidemiology of autism and its spectrum disorders) suggests that the issue may not be so clearcut.

    Semantics aside, there is much to recommend this book. There is a clear guide to the classification of autistic syndromes and diagnostic criteria with advice on practical application. There is a chapter about diagnosis in infancy including a fascinating list of physical signs associated with autism (this reviewer was previously unaware of the possible significance of partial syndactyly of 2nd and 3rd toes). There is less discussion, however, of the benefits of early diagnosis or of the implications of error in making such a diagnosis. The chapter on the clinical course of autism emphasises the dynamic nature of the condition and the real possibility of changes during adolescence. The next chapter logically deals with adults with autism although emphasising our lack of knowledge of this subject with its brevity.

    The new edition has a chapter entitled “Double syndromes” replacing a group of chapters in the previous edition under the heading of “Disease entities that have a subgroup of patients with autistic symptoms”. I am not yet convinced that it is helpful to describe many patients with some autistic features associated with a clear primary diagnosis as having two separate disease entities.

    The controversy over the possible links with MMR immunisation is discussed briefly but in a balanced fashion with pointers to emerging research into the apparent link between autism and some gastrointestinal disorders.

    Discussion of possible therapies, medical and non-medical, is fairly brief (perhaps appropriately so in a text dealing with the biology of autism) but provides a good summary of current approaches. This book provides a good overview of the subject of autism (whether syndromes or spectrum) and will be of use to all paediatricians dealing with children with the diagnosis. This reviewer will be interested to see if the interval until the next edition passes so quickly . . ..

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