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David H Skuse, The Medicine Publishing Company, 2003, £29.00, pp 211. ISBN 0-953259-85-4
When this book arrived I opened the package and thought it was another government document with its glossy purple headed pages. The impressive list of contributors suggested a treat in store.
There seemed to be a consistency on initial browsing that deserved closer investigation. All the chapters are approximately 2000 words long, running into four or five pages depending on the number of tables and diagrams. The preface confirmed that this was a series of articles from Psychiatry rather than a textbook.
The book is divided into eight parts; the first four cover normal development, assessment, family and genetic influences, and classification. Developmental disorders follow and with some poetic licence include the development of blind and deaf children. The largest part is psychiatric disorders in which ADHD, epilepsy, and acquired brain injury are incorporated. Management and treatment issues, and child psychiatry and the law complete the text.
The challenge had to be how to achieve a balance and consistency in the overall information presented, particularly as it was aimed at students and professions allied to medicine as well as clinicians. One four page chapter on autism spectrum disorder and another of the same length on attention deficit hyperactivity disorder does not balance well with the same amount of space devoted to specialist neuropsychological assessment procedures. Asperger’s syndrome merits four sentences throughout the whole text. One of these reduces it to “a diagnosis of uncertain nosological validity”—Tony Attwood take note.
There is a good section on normal development that belongs in an introductory book such as this. The assessment chapters consist of too many lists of tests rather than explanation of their place in clinical practice.
The specific learning difficulty (SLD) chapter starts with a thoroughly confusing paragraph for someone who believes severe learning difficulty is abbreviated SLD.
Under diagnostic classification systems the multiaxial diagnosis approach is described. This moves away from giving children a single diagnostic label and more towards a description of their overall functioning. Hopefully this approach will be used more in the future. Hyperkinetic disorders are classified as psychiatric disorders here and as a neurodevelopmental disorder elsewhere. To parents and children it is an important distinction.
David Skuse’s personnel contribution on behavioural phenotypes was fascinating. The fact that Huntingdon’s chorea gene carriers have a highly selective deficit in the recognition of the facial expression of disgust was intriguing, but not really introductory material.
A valiant attempt was made to condense medical treatments into the allotted 2000 words. It had to be cursory; longer acting methylphenidate preparations do not get a mention but bupropion is suggested as a third line treatment for ADHD because it can be given once daily.
The paediatric liaison section is somewhat paranoiac and fails to mention the close working relations developing in many districts between community paediatric and child and mental health services teams (CAMHS).
Each monograph has its own merits; the academic bias of some of them widens the appeal to a more experienced readership. Subsequent editions are promised, so some of the gaps can be plugged. Students will then have a more balanced view of what is relevant in clinical practice. This will then become a deservedly popular book.